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Individual

MRS. KELLY CANNON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
APRN, FNP-BC

Contact information

Practice address
1700 S 23RD ST, FORT PIERCE, FL 34950-4803
(772) 461-4000
Mailing address
210 JUPITER LAKES BLVD STE 4105, JUPITER, FL 33458-7190
(561) 743-9938
(561) 575-0801

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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