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General NPI Number Information
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NPI Number | 1790065738
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Entity Type | Individual
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Provider Name | CAMERON STEPHENSON NP
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Gender | Male
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Dates
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Enumeration Date | 08/22/2011
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Last Update Date | 02/04/2026
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Provider Practice Location Address
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Address Line | 393 E 2ND N
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City | REXBURG
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State | ID
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Zip | 83440-1605
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Country | US
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Telephone | 208-359-6498
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Fax | 208-488-4702
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Provider Business Mailing Address
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Address Line | 393 E 2ND N
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City | REXBURG
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State | ID
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Zip | 83440-1605
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Country | US
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Telephone | 208-359-6498
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Fax | 208-488-4702
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 3009120
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 75884
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License Number State | ID
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