# MRS. KIMBERLY CANNON

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1578940656
- **Gender:** F
- **Credential:** AGPCNP-BC

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | 4704259824 | MI | Yes |

## Other

- **Enumeration date:** 04/28/2015
- **Last updated:** 04/28/2015

## 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 |