MEDICARE: CAMELLA DAWN LADD FNP-C

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	363LF0000X	Family Nurse Practitioner	AP144298	TX

General Provider Information

NPI Number	:	1952931693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMELLA DAWN LADD FNP-C

Provider Business Mailing Address
First Line	:	PO BOX 840026
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-0026
Country	:	US
Telephone Number	:	806-212-6353
Fax Number	:	806-212-0559

Provider Business Practice Location Address
First Line	:	3501 S SONCY RD STE 150
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79119-6426
Country	:	US
Telephone Number	:	806-212-6353
Fax Number	:	806-212-0559

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

Provider Enumeration Date	:	01/22/2020
Last Update Date	:	09/21/2022

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