Healthcare Provider Details

I. General information

NPI: 1487807384
Provider Name (Legal Business Name): LAUREE DANIELLE CAMERON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2008
Last Update Date: 07/01/2021
Certification Date: 07/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9430 PARK WEST BLVD STE 130
KNOXVILLE TN
37923-4205
US

IV. Provider business mailing address

363 W MAIN ST
LEWISVILLE TX
75057-3867
US

V. Phone/Fax

Practice location:
  • Phone: 865-690-4861
  • Fax: 865-560-8525
Mailing address:
  • Phone: 972-436-4434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1150
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number1150
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1150
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: