Provider Demographics
NPI:1811330640
Name:CAMERON, KELLY NICOLE SMITH (DO)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:NICOLE SMITH
Last Name:CAMERON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 58538
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-8538
Mailing Address - Country:US
Mailing Address - Phone:281-747-9655
Mailing Address - Fax:281-724-1857
Practice Address - Street 1:500 N KOBAYASHI STE A
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4722
Practice Address - Country:US
Practice Address - Phone:281-747-9655
Practice Address - Fax:281-724-1857
Is Sole Proprietor?:No
Enumeration Date:2013-04-11
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXR2547208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation