Provider Demographics
NPI:1982423364
Name:KINGSFORD, CAMMY (APRN)
Entity type:Individual
Prefix:
First Name:CAMMY
Middle Name:
Last Name:KINGSFORD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CAMMY
Other - Middle Name:
Other - Last Name:KINGSFORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:1029 E 900 N
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-2718
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:444 W BOURNE CIR STE 200
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-3657
Practice Address - Country:US
Practice Address - Phone:801-776-0174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14104271363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty