Provider Demographics
NPI:1194481259
Name:CAMERON, JACKLYN GRACE MARIE
Entity type:Individual
Prefix:
First Name:JACKLYN
Middle Name:GRACE MARIE
Last Name:CAMERON
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 1:439 ELBURZ RD UNIT 15
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-7500
Mailing Address - Country:US
Mailing Address - Phone:406-320-1620
Mailing Address - Fax:
Practice Address - Street 1:1830 E SAHARA AVE STE 113
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-3738
Practice Address - Country:US
Practice Address - Phone:877-786-4999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-12
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide