Provider Demographics
NPI:1114211372
Name:CAMERON, RUSTIN FOREST (PA-C)
Entity type:Individual
Prefix:MR
First Name:RUSTIN
Middle Name:FOREST
Last Name:CAMERON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:763 MAIN ST N
Mailing Address - Street 2:
Mailing Address - City:MC KENZIE
Mailing Address - State:TN
Mailing Address - Zip Code:38201-1723
Mailing Address - Country:US
Mailing Address - Phone:731-358-0973
Mailing Address - Fax:
Practice Address - Street 1:763 MAIN ST N
Practice Address - Street 2:
Practice Address - City:MC KENZIE
Practice Address - State:TN
Practice Address - Zip Code:38201-1723
Practice Address - Country:US
Practice Address - Phone:731-358-0973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant