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General NPI Number Information
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NPI Number | 1518553403
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Entity Type | Individual
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Provider Name | JACKIE R CAMP NP
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Gender | Female
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Dates
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Enumeration Date | 12/15/2020
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 213 NW 10TH ST
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City | FAIRFIELD
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State | IL
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Zip | 62837-1216
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Country | US
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Telephone | 618-842-4617
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Fax | 618-380-4565
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Provider Business Mailing Address
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Address Line | 213 NW 10TH ST
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City | FAIRFIELD
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State | IL
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Zip | 62837-1216
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Country | US
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Telephone | 618-842-4617
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Fax | 618-380-4565
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 28156286A
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License Number State | IN
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