MEDICARE: CAMERON BLAKE LITTLE FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LC0200X	Critical Care Medicine Nurse Practitioner	5014135	NC
2	363L00000X	Nurse Practitioner	5014135	NC
3	363LF0000X	Family Nurse Practitioner	APRN.CNP.0040906	OH
4	363LF0000X	Family Nurse Practitioner	5014135	NC

General Provider Information

NPI Number	:	1700486685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMERON BLAKE LITTLE FNP

Provider Business Mailing Address
First Line	:	1949 BLACKWOLF RUN LN
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27604-5405
Country	:	US
Telephone Number	:	252-299-2658
Fax Number	:

Provider Business Practice Location Address
First Line	:	1010 CEREAL AVE STE 207
Second Line	:
City	:	HAMILTON
State	:	OH
Zip	:	45013-2772
Country	:	US
Telephone Number	:	513-867-3331
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/29/2020
Last Update Date	:	06/04/2026

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