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Individual
MRS. KIMBERLY CANNON
Active
Individual
MRS. KIMBERLY CANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AGPCNP-BC
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704259824
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2014018630
AMERICAN NURSES CREDENTIALING CENTER CERTIFICATION
MI
01
—
4704259824
STATE OF MICHIGAN, BOARD OF NURSING, NURSE PRACTITIONER LICENSE
MI
Enumeration date
04/28/2015
Last updated
04/28/2015
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