Healthcare Provider Details

I. General information

NPI: 1134049497
Provider Name (Legal Business Name): KIMBERLY MCCANN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1280 BOARDMAN CANFIELD RD STE 3
BOARDMAN OH
44512-4073
US

IV. Provider business mailing address

1280 BOARDMAN CANFIELD RD STE 3
BOARDMAN OH
44512-4073
US

V. Phone/Fax

Practice location:
  • Phone: 330-726-1900
  • Fax: 330-726-0843
Mailing address:
  • Phone: 330-726-1900
  • Fax: 330-726-0843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0042654
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: