Healthcare Provider Details

I. General information

NPI: 1720794407
Provider Name (Legal Business Name): KIMBERLY MICHELLE CANN CERTIFIED LIFE COACH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2023
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 EASTON RD STE 1
WILLOW GROVE PA
19090-2520
US

IV. Provider business mailing address

7122 GERMANTOWN AVE
PHILADELPHIA PA
19119-1837
US

V. Phone/Fax

Practice location:
  • Phone: 215-971-6546
  • Fax: 877-335-7753
Mailing address:
  • Phone: 215-971-6546
  • Fax: 877-335-7753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175L00000X
TaxonomyHomeopath
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374T00000X
TaxonomyReligious Nonmedical Nursing Personnel
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: