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MRS. KIMBERLY CANNON AGPCNP-BC
NPI 1578940656
Nurse Practitioner in Saint Clair Shores, MI

Active since April 28, 2015PECOS Enrolled
28315 HARPER AVE, SAINT CLAIR SHORES, MI 48081(586) 552-1710 Get Directions Write a Review

NPPES record last updated: April 28, 2015. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Mrs. Kimberly Cannon Agpcnp-bc NPPES

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

MRS. KIMBERLY CANNON AGPCNP-BC (NPI 1578940656) is an individual nurse practitioner in Saint Clair Shores, Michigan, licensed in Michigan (4704259824) and active in the NPI registry since April 2015. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1578940656
Entity TypeIndividualFemale
Primary Taxonomy363L00000X
Provider Legal NameMRS. KIMBERLY CANNONCredential: AGPCNP-BC
Location Address28315 HARPER AVESaint Clair Shores, MI 48081-1687
Mailing Address28315 Harper AveSaint Clair Shores, MI 48081-1687 · (586) 552-1710
Phone(586) 552-1710
Sole ProprietorYes
Enumeration DateApril 28, 2015
✔ NPI 1578940656 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363L00000X
License✔ Licensed in MI · 4704259824
Definition
(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.
28315 HARPER AVE, Saint Clair Shores, MI 48081
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Other Names 1

Former Name (1)Kimberly Buchanan

Other Identifiers 2

Other4704259824MI · State Of Michigan, Board Of Nursing, Nurse Practitioner License
Other2014018630MI · American Nurses Credentialing Center Certification

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

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

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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 48081 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.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

WENDY SUE ROBINSON NP
Nurse Practitioner (Family)
28315 HARPER AVE
SAINT CLAIR SHORES, MI 48081
Macomb County (586) 552-1710
EIM CHOICE CARE PC
Internal Medicine
28315 HARPER AVE
ST CLAIR SHORES, MI 48081
Macomb County (586) 552-1710
EASTSIDE INTERNAL MEDICINE PC
Internal Medicine
28315 HARPER AVE
SAINT CLAIR SHORES, MI 48081
Macomb County (586) 552-1710

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 1578940656. It was assigned to this individual provider in the NPPES registry on April 28, 2015. The provider is also known as Kimberly Buchanan.

Where is Kimberly Cannon located?

Kimberly Cannon practices at 28315 Harper Ave, Saint Clair Shores, MI 48081. The listed phone number is (586) 552-1710.

What is Kimberly Cannon's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Is Kimberly Cannon enrolled in Medicare?

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

When was this NPI record last updated?

The NPPES record for Kimberly Cannon was last updated on April 28, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 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.