Provider Demographics
NPI:1114561867
Name:CROMWELL, CAMESHA
Entity type:Individual
Prefix:
First Name:CAMESHA
Middle Name:
Last Name:CROMWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4441 W AIRPORT FWY STE 340
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-5960
Mailing Address - Country:US
Mailing Address - Phone:870-500-3308
Mailing Address - Fax:
Practice Address - Street 1:4441 W AIRPORT FWY STE 340
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-5960
Practice Address - Country:US
Practice Address - Phone:870-500-3308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-05
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR236837795Medicaid