Cannon, Kimberly

Cannon, Kimberly is an sole proprietor health care provider with primary practice located at 28315 Harper Ave , Saint Clair Shores MI 48081-1687. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, which is considered as her primary health care specialty. Cannon, Kimberly can be contacted via phone (586) 552-1710.

Contact Information

Primary practice address
28315 Harper Ave Saint Clair Shores MI 48081-1687
Fax:
Website:

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 4704259824 Michigan

Profile Details

NPI number 1578940656
LBN Legal business name Cannon, Kimberly
Credentials AGPCNP-BC
Entity Individual
Sole proprietor 1 Yes
Enumeration date Apr 28th, 2015
Last updated Apr 28th, 2015 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1578940656 NPPES
Michigan Other 2014018630 AMERICAN NURSES CREDENTIALING CENTER CERTIFICATION
Michigan Other 4704259824 AMERICAN NURSES CREDENTIALING CENTER CERTIFICATION

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