Healthcare Provider Details

I. General information

NPI: 1114636172
Provider Name (Legal Business Name): DAWNIELLA CAMERO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2022
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 W LINCOLN TRAIL BLVD
RADCLIFF KY
40160-2011
US

IV. Provider business mailing address

83 FUDGE LN
ELIZABETHTOWN KY
42701-9772
US

V. Phone/Fax

Practice location:
  • Phone: 270-352-1133
  • Fax:
Mailing address:
  • Phone: 270-401-7885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number296743
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: