MEDICARE: PRISCILLA CAMERON 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	27882	TN

General Provider Information

NPI Number	:	1992318653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRISCILLA CAMERON FNP-C

Provider Business Mailing Address
First Line	:	9360 LAKESHORE DR
Second Line	:
City	:	RUTLEDGE
State	:	TN
Zip	:	37861-5907
Country	:	US
Telephone Number	:	423-312-3596
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 HESTER LN
Second Line	:
City	:	TAZEWELL
State	:	TN
Zip	:	37879-5088
Country	:	US
Telephone Number	:	423-851-4594
Fax Number	:	423-851-4595

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

Provider Enumeration Date	:	08/24/2020
Last Update Date	:	02/23/2022

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