MEDICARE: CAMERON MCCAUGHERTY FNP, RN

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	163W00000X	Registered Nurse	RN61415185	WA
2	363LF0000X	Family Nurse Practitioner	353794	NY
3	163W00000X	Registered Nurse	175382	CT
4	163W00000X	Registered Nurse	891195	NY
5	163W00000X	Registered Nurse	RN2349912	MA

General Provider Information

NPI Number	:	1952175549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMERON MCCAUGHERTY FNP, RN

Provider Business Mailing Address
First Line	:	356 W 18TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10011-4401
Country	:	US
Telephone Number	:	212-271-7200
Fax Number	:	212-271-7225

Provider Business Practice Location Address
First Line	:	356 W 18TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10011-4401
Country	:	US
Telephone Number	:	212-271-7200
Fax Number	:	212-271-7225

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

Provider Enumeration Date	:	11/14/2023
Last Update Date	:	02/09/2026

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