Individual
MS. KIMBERLY LYNN CANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
3857 COOPER ST, JACKSON, MI 49201-7547
(517) 780-5600
Mailing address
5039 PAGE AVE, JACKSON, MI 49201-9101
(313) 713-4543
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704304007
MI
Other
Enumeration date
09/12/2017
Last updated
03/17/2018
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