Provider Demographics
NPI:1992318653
Name:CAMERON, PRISCILLA (FNP-C)
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:
Last Name:CAMERON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9360 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:RUTLEDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37861-5907
Mailing Address - Country:US
Mailing Address - Phone:423-312-3596
Mailing Address - Fax:
Practice Address - Street 1:150 HESTER LN
Practice Address - Street 2:
Practice Address - City:TAZEWELL
Practice Address - State:TN
Practice Address - Zip Code:37879-5088
Practice Address - Country:US
Practice Address - Phone:423-851-4594
Practice Address - Fax:423-851-4595
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27882363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily