MRS. KIMBERLY CANNON (NPI# 1578940656) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578940656 |
| Entity Type | Individual |
| Full Name | MRS. KIMBERLY CANNON |
| Other Name | KIMBERLY BUCHANAN |
| Credential | AGPCNP-BC |
| Practice Address |
28315 Harper Ave Saint Clair Shores MI 48081-1687 |
| Practice Telephone | 5865521710 |
| Mailing Telephone | 5865521710 |
| Enumeration Date | 2015-04-28 |
| Last Update Date | 2015-04-28 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363L00000X | Nurse Practitioner | 4704259824 | MI | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | AMERICAN NURSES CREDENTIALING CENTER CERTIFICATION | 2014018630 | 01 |
| MI | STATE OF MICHIGAN, BOARD OF NURSING, NURSE PRACTITIONER LICENSE | 4704259824 | 01 |
| 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 |
| 1407375207 | Kimberly Lynn Cannon | Nurse Practitioner | 3857 Cooper St, Jackson, MI 49201-7547 | 2017-09-12 |
| 1528396447 | Kimberly M Cannon | Counselor | 223 E Main St, Suite 300, Rock Hill, SC 29730-4571 | 2009-12-04 |
| Street Address |
28315 HARPER AVE |
| City | SAINT CLAIR SHORES |
| State | MI |
| Zip Code | 48081-1687 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831201821 | Eastside Internal Medicine PC | Internal Medicine | 28315 Harper Ave, Saint Clair Shores, MI 48081-1687 | 2006-08-31 |
| 1255761250 | Wendy Sue Robinson | Nurse Practitioner | 28315 Harper Ave, Saint Clair Shores, MI 48081-1687 | 2013-11-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750865416 | Saint Clair Family Pharmacy LLC | Pharmacy | 28001 Harper Ave., Saint Clair Shores, MI 48081 | 2018-09-19 |
| 1669995783 | Terra Laquay Ginther | Social Worker | 28800 Harper Ave Ste A, Saint Clair Shores, MI 48081 | 2017-07-20 |
| 1245676998 | Julia Hanson | Social Worker | 27941 Harper Ave., Suite 105, St. Clair Shores, MI 48081 | 2013-05-21 |
| 1760731301 | Life Transition Service | Community/Behavioral Health | 21031 Sunnydale, St. Clair Shore, MI 48081 | 2012-08-29 |
| 1477868792 | William Burr Wood | Pharmacist | 21000 Twelve Milerd., St Clair Shores, MI 48081 | 2010-08-11 |
| 1508094350 | Dominic Anthony Garrisi | Anesthesiology | 21018 Bon Brae, St. Clair Shores, MI 48081 | 2009-06-30 |
| 1992947022 | Karen Ostrowski-thomas | Occupational Therapist | 22442 Bayview, St. Clair Shores, MI 48081 | 2009-04-06 |
| 1891979787 | Chirag Rachhadia | Physical Therapist | 29150 Harper Avenue, St. Clair Shores, MI 48081 | 2007-12-27 |
| 1598955114 | Donna Warner Manczak | Psychologist | 21400 E Eleven Mil Rd, St Clair Shores, MI 48081 | 2007-07-30 |
| 1467652347 | Sumit Narayanprasad Fogla | Family Medicine | 21400 E Eleven Mile Road, St. Clair Shores, MI 48081 | 2007-07-19 |
| Find all providers in zip 48081 | ||||
| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801316989 | Olivia Charlotte-anne Murthy | Nurse Practitioner | 23715 Little Mack Ave Ste A, Saint Clair Shores, MI 48080-1181 | 2017-06-21 |
| 1427690734 | Stefan M Smolenski | Nurse Practitioner | 23829 Little Mack Ave Ste 100, Saint Clair Shores, MI 48080-1186 | 2019-10-09 |
| 1639656721 | Kali M Mcleod | Nurse Practitioner | 28001 Harper Ave, Saint Clair Shores, MI 48081-1561 | 2018-07-23 |
| 1881107738 | Meghan Elizabeth Gallagher | Nurse Practitioner | 24715 Little Mack Ave Ste 100, Saint Clair Shores, MI 48080-3207 | 2017-11-14 |
| 1649525288 | Elizabeth Perrotta | Nurse Practitioner | 23715 Little Mack Ave Ste 100, Saint Clair Shores, MI 48080-1181 | 2012-07-19 |
| 1801018338 | Michigan Institute of Urology PC | Nurse Practitioner | 20952 E 12 Mile Rd, Suite 200, Saint Clair Shores, MI 48081-3200 | 2007-05-03 |
| 1720107089 | Cheryl Lang | Nurse Practitioner | 19699 E 8 Mile Rd, Saint Clair Shores, MI 48080-1655 | 2007-03-28 |
| 1992742753 | Jean A Edmondson | Nurse Practitioner | 23829 Little Mack Ave, Suite 100, Saint Clair Shores, MI 48080-1186 | 2006-06-01 |
| 1295781540 | Linda Mcparlan | Nurse Practitioner | 23829 Little Mack Ave, Suite 100, Saint Clair Shores, MI 48080-1186 | 2006-05-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477154599 | Kelly Phuong Doan | Nurse Practitioner | 27327 23 Mile Rd, Chesterfield, MI 48051-2045 | 2020-11-04 |
| 1275133217 | Maureen Mae Lewis | Nurse Practitioner | 2782 N Coleman Rd, Coleman, MI 48618-9721 | 2020-10-29 |
| 1073113460 | Taylor L Pichette | Nurse Practitioner | 758 Lucille Dr, Wolverine Lake, MI 48390-2327 | 2020-10-27 |
| 1295333938 | Amanda Covell | Nurse Practitioner | 624 Cherry St Se Apt 5, Grand Rapids, MI 49503-4778 | 2020-10-14 |
| 1689271314 | Nicole Conklin | Nurse Practitioner | 524 Doyle Rd, Laingsburg, MI 48848-9611 | 2020-10-06 |
| 1447857677 | Shelby Lynn Waibel | Nurse Practitioner | 560 W Mitchell St Ste 210, Petoskey, MI 49770-2276 | 2020-10-01 |
| 1497361638 | Amira Aljamal | Nurse Practitioner | 4601 Shenandoah Ave, Allen Park, MI 48101-3131 | 2020-09-22 |
| 1659987014 | Sean Thomas Kane | Nurse Practitioner | 13734 Parallel Ave, Alpena, MI 49707-7987 | 2020-09-21 |
| 1235743592 | Mojica, LLC | Nurse Practitioner | 4163 W Pointe Dr, Waterford, MI 48329-4648 | 2020-09-03 |
| 1942812094 | Meagan James | Nurse Practitioner | 407 E Huron River Dr, Belleville, MI 48111-2763 | 2020-08-20 |
| Find all providers with the same taxonomy | ||||
| City | SAINT CLAIR SHORES |
| Zip Code | 48081 |
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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.