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General NPI Number Information
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NPI Number | 1336595305
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Entity Type | Individual
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Provider Name | HEIDI CAMERON L.AC
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Gender | Female
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Dates
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Enumeration Date | 05/10/2016
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Last Update Date | 05/10/2016
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Provider Practice Location Address
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Address Line | 2889B IDAHO AVENUE
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City | FORT CAMPBELL
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State | KY
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Zip | 42223
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Country | US
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Telephone | 512-534-5404
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Fax |
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Provider Business Mailing Address
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Address Line | 15005 FORT CAMPBELL BLVD.
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City | OAK GROVE
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State | KY
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Zip | 42262
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Country | US
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Telephone | 512-534-5404
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC109
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | ACU0000000281
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License Number State | TN
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