Healthcare Provider Details

I. General information

NPI: 1174370118
Provider Name (Legal Business Name): CAMILLE J BANKHEAD FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CAMILLE J VERNON

II. Dates (important events)

Enumeration Date: 05/06/2024
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6675 BUSINESS PKWY STE F
ELKRIDGE MD
21075-6349
US

IV. Provider business mailing address

6675 BUSINESS PKWY STE F
ELKRIDGE MD
21075-6349
US

V. Phone/Fax

Practice location:
  • Phone: 866-799-5886
  • Fax:
Mailing address:
  • Phone: 866-799-5886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7473051-8900
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7473051-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: