MS. KIMBERLY LYNN CANNON (NPI# 1407375207) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407375207 |
| Entity Type | Individual |
| Full Name | MS. KIMBERLY LYNN CANNON |
| Credential | FNP-BC |
| Practice Address |
3857 Cooper St Jackson MI 49201-7547 |
| Mailing Address |
5039 Page Ave Jackson MI 49201-9101 |
| Practice Telephone | 5177805600 |
| Mailing Telephone | 3137134543 |
| Enumeration Date | 2017-09-12 |
| Last Update Date | 2018-03-17 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
4704304007 | MI | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 30999 Morlock St # 924, Livonia, MI 481521662 | 3137134543 | 3137134543 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700282084 | Kimberly Cannon | Occupational Therapist | 27 Carter Street, Richmond Hills, GA 31324 | 2014-11-13 |
| 1558838896 | Kimberly Cannon | Nurse Practitioner | 865 N Arizola Rd, Casa Grande, AZ 85122-6011 | 2018-10-24 |
| 1578940656 | Kimberly Cannon | Nurse Practitioner | 28315 Harper Ave, Saint Clair Shores, MI 48081-1687 | 2015-04-28 |
| 1528396447 | Kimberly M Cannon | Counselor | 223 E Main St, Suite 300, Rock Hill, SC 29730-4571 | 2009-12-04 |
| Street Address |
3857 COOPER ST |
| City | JACKSON |
| State | MI |
| Zip Code | 49201-7547 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104021765 | Lynn M Larson | Internal Medicine | 3857 Cooper St, Jackson, MI 49201-7547 | 2007-06-15 |
| 1215597414 | Matthew Kuiper | Dentist | 3857 Cooper St, Jackson, MI 49201-7547 | 2019-06-19 |
| 1285115931 | Mobile Medical Pros Pllc | Surgery | 3857 Cooper St, Jackson, MI 49201-7547 | 2018-08-21 |
| 1770031957 | Duane Waters Correctional Pharmacy | Clinic/Center | 3857 Cooper St, Jackson, MI 49201-7547 | 2016-09-15 |
| 1578913935 | James Michael Mcnamara | Physician Assistant | 3857 Cooper St, Jackson, MI 49201-7547 | 2016-06-16 |
| 1922402429 | Harry Williams | Dentist | 3857 Cooper St, Jackson, MI 49201-7547 | 2014-10-14 |
| 1306272182 | Danielle Sandella Alford | Physician Assistant | 3857 Cooper St, Jackson, MI 49201 | 2013-09-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174137863 | Sally Ann Shaw | Behavior Technician | 3699 Miles Rd., Jackson, MI 49201 | 2020-09-01 |
| 1780293043 | Alyn Kristin Kay | Technician | Hope Network-hope's Door Cru, 3699 Miles Rd., Jackson, MI 49201 | 2020-07-23 |
| 1841827946 | Maverick Jubane | Student in an Organized Health Care Education/Training Program | Henry Ford Allegiance Health, 205 N East Avenue, Jackson, MI 49201 | 2020-03-26 |
| 1306486584 | Cody Williams | Technician, Other | 1001 Laurence Avenue St E, Jackson, MI 49201 | 2020-01-15 |
| 1720632292 | Krystie Lynn Adorjan | Speech-Language Pathologist | 1175 W Parnall Rd, Jackson, MI 49201 | 2019-08-01 |
| 1407412653 | Howard Franklin Tanner II | Speech-Language Pathologist | 102 East Michigan Avenue, Jackson, MI 49201 | 2019-05-14 |
| 1356863740 | Rima Zarar Qayyum | Speech-Language Pathologist | 4800 Firethorn Dr., Jackson, MI 49201 | 2017-07-07 |
| 1306384383 | Briana Nesmith | Speech-Language Pathologist | 2025 Ann Arbor Road, Jackson, MI 49201 | 2017-02-09 |
| 1255878062 | W.a. Foote Memorial Hospital, Inc | Otolaryngology | 205 N.east Ave, Jackson, MI 49201 | 2017-01-31 |
| 1306212881 | Aisha Henderson | Social Worker | 729 West Michigan Avenue, Jackson, MI 49201 | 2015-08-19 |
| Find all providers in zip 49201 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073113627 | Jessicah Blasdel | Nurse Practitioner | 113 W Michigan Ave, Jackson, MI 49201-1340 | 2020-10-31 |
| 1801406335 | Jade Russell | Nurse Practitioner | 2205 W Morrell St, Jackson, MI 49203-1357 | 2020-08-10 |
| 1992315212 | Patrecia Campbell | Nurse Practitioner | 2570 Bailey Ave Ste 7, Jackson, MS 39213-6905 | 2020-08-01 |
| 1669008926 | Kristine Edwards | Nurse Practitioner | 723 Woodlawn Ave, Jackson, MI 49203-2921 | 2020-03-19 |
| 1295366391 | Christy White | Nurse Practitioner | 363 Old Pinson Rd, Jackson, TN 38301-9576 | 2020-01-28 |
| 1972141620 | Primary Care - Bemis, LLC | Nurse Practitioner | 1385 S Highland Ave Ste B4, Jackson, TN 38301-7547 | 2019-12-12 |
| 1174164263 | Tami Anne Miller | Nurse Practitioner | 124 N Bast St, Jackson, MO 63755-1704 | 2019-10-01 |
| 1265080584 | Cameron Nicole Howard | Nurse Practitioner | 1860 Chadwick Dr Ste 256, Jackson, MS 39204-3486 | 2019-08-29 |
| 1831750843 | Rhiannon Michelle Andresen | Nurse Practitioner | 1022 Greystone Sq, Jackson, TN 38305-3580 | 2019-06-21 |
| 1902376361 | Jenay B Krumm | Nurse Practitioner | 1201 E Michigan Ave Ste 200, Jackson, MI 49201-1855 | 2018-11-28 |
| Find all providers in JACKSON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.