Provider Demographics
NPI:1386829513
Name:CAMERON, JENNIFER A (PHD, CRNP)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:A
Last Name:CAMERON
Suffix:
Gender:F
Credentials:PHD, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7304
Mailing Address - Country:US
Mailing Address - Phone:301-580-9160
Mailing Address - Fax:910-763-3311
Practice Address - Street 1:1121 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7304
Practice Address - Country:US
Practice Address - Phone:910-763-8134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-07
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC001028363LP0808X
NC5214103T00000X
VA0810002942103TB0200X
MD05258103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral