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Individual
MRS. KELLY CANNON
Active
Individual
MRS. KELLY CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, FNP-BC
Taxonomy
Speciality
Code
Description
License number
State
163WE0003X
Emergency Registered Nurse
RN9312491
FL
363L00000X
Nurse Practitioner
Primary
APRN11005031
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1184270209
MEDICARE MEDICAID AND OTHER
FL
Enumeration date
08/14/2019
Last updated
10/23/2024
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