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MS. KIMBERLY LYNN CANNON FNP-BC
NPI 1407375207
Nurse Practitioner - Family in Livonia, MI

Active since September 12, 2017PECOS Enrolled
30999 MORLOCK ST # 924, LIVONIA, MI 48152(313) 713-4543(313) 713-4543 Get Directions Write a Review

NPPES record last updated: March 17, 2018. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Mar 17, 2018, Sep 12, 2017 (2 updates tracked since 2017).

About Ms. Kimberly Lynn Cannon Fnp-bc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MS. KIMBERLY LYNN CANNON FNP-BC (NPI 1407375207) is an individual family provider in Livonia, Michigan, licensed in Michigan (4704304007) and active in the NPI registry since September 2017. She is enrolled in Medicare PECOS, maintains a secondary practice location in Livonia, and is a graduate of Other (2009).

NPPES Registry Identity

NPI1407375207
Entity TypeIndividualFemale
Primary Taxonomy363LF0000X
Provider Legal NameMS. KIMBERLY LYNN CANNONCredential: FNP-BC
Location Address30999 MORLOCK ST # 924Livonia, MI 48152-1662
Mailing Address5039 Page AveJackson, MI 49201-9101 · (313) 713-4543
Phone(313) 713-4543
Fax(313) 713-4543
Sole ProprietorYes
Medical School CMSOtherGraduated 2009
Enumeration DateSeptember 12, 2017
Last NPPES UpdateMarch 17, 20182 updates tracked since enumeration
✔ NPI 1407375207 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
License✔ Licensed in MI · 4704304007
30999 MORLOCK ST # 924, Livonia, MI 48152
Open in Google Maps ↗

Secondary Practice Location 1

Location 130999 Morlock St # 924Livonia, MI 48152-1662 · Phone (313) 713-4543 · Fax (313) 713-4543

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Ms. Kimberly Lynn Cannon Fnp-bc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID8325585201
PECOS Enrollment IDI20251110000888
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

2

Medicare enrollment records show Kimberly Cannon reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Theoria Medical
6.2 mi
Internal Medicine
41800 W 11 MILE RD STE 109
Novi, MI 48375
  • Reassigned Medicare billing, Michigan enrollment
  • 383 clinicians in this Medicare group
NPI 1609362375 (248) 860-4634
Thrive Counseling LLC
412 mi
Mental Health
1000 JEFFERSON ST STE 2C
Lynchburg, VA 24504
  • Reassigned Medicare billing, South Carolina enrollment
  • 80 clinicians in this Medicare group
NPI 1215181300 (855) 284-7483

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 48152 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$90.76 typical visit price
range $58.04 – $177.36
Typical copayment $22.69 (range $14.51 – $44.34)
Most-billed visit code 99203
Established Patient
$102.35 typical visit price
range $18.32 – $143.49
Typical copayment $25.58 (range $4.58 – $35.87)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kimberly Cannon's NPI number?

The NPI number for Kimberly Cannon is 1407375207. It was assigned to this individual provider in the NPPES registry on September 12, 2017.

Where is Kimberly Cannon located?

Kimberly Cannon practices at 30999 Morlock St # 924, Livonia, MI 48152. The listed phone number is (313) 713-4543.

What is Kimberly Cannon's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Is Kimberly Cannon enrolled in Medicare?

Yes. Kimberly Cannon is registered in the Medicare PECOS enrollment system.

Which organizations bill Medicare for Kimberly Cannon's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Kimberly Cannon reassigns Medicare benefits to 2 organizations: Theoria Medical (Novi, MI) and Thrive Counseling LLC (Lynchburg, VA). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Kimberly Cannon's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Kimberly Cannon was last updated on March 17, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.