Individual provider Active NPI

Kimberly Brooke McCann, MSN, CPNP-PC, CNS

  • Pediatric Nurse Practitioner
  • Santa Cruz, CA
National Provider Identifier
1053821553
Registry record updated Feb 12, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
95007438 Issued in CA
Practice address
1510 Capitola Rd
Santa Cruz, CA 95062-2912
Phone
(831) 427-3500
NPI assigned
Oct 10, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 95007438 CA Primary
Pediatric Clinical Nurse Specialist 364SP0200X 4636 CA

Addresses

Primary practice location

1510 Capitola Rd
Santa Cruz, CA 95062-2912

Mailing address

PO Box 542
Santa Cruz, CA 95061-0542
Phone (831) 427-3500

Other practice location 1

130 Riverside Dr
Boulder Creek, CA 95006-9432
Phone (310) 780-8723

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260423001363 CA Order and Referring Only - Nurse Practitioner 9436626801

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Specialist, Master of Science - Nursing

State licenses

LicenseStateTypeSpecialty
95007438CAMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Santa Cruz Community Health Centers Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1507593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1770854400000",
    "number": "1053821553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 542",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950610542",
            "telephone_number": "831-427-3500",
            "fax_number": "831-427-7785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1510 CAPITOLA RD",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950622912",
            "telephone_number": "831-427-3500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "130 Riverside Dr",
            "address_purpose": "LOCATION",
            "city": "Boulder Creek",
            "state": "CA",
            "postal_code": "950069432",
            "country_code": "US",
            "telephone_number": "310-780-8723",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCCANN",
        "first_name": "KIMBERLY",
        "middle_name": "BROOKE",
        "name_prefix": "Ms.",
        "credential": "MSN, CPNP-PC, CNS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-10",
        "last_updated": "2026-02-12",
        "certification_date": "2026-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "CA",
            "license": "95007438",
            "primary": true
        },
        {
            "code": "364SP0200X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Pediatrics",
            "state": "CA",
            "license": "4636",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Cruz, CA

Sources for this page

Verify at the official NPI Registry.