Basic Information
| Provider Information | |||||||||
| NPI: | 1053635391 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAMERON | ||||||||
| FirstName: | TRACI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 901 TURTLE CREEK DR | ||||||||
| Address2: | |||||||||
| City: | TYLER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757011947 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9035963588 | ||||||||
| FaxNumber: | 9035942038 | ||||||||
| Practice Location | |||||||||
| Address1: | 203 NACOGDOCHES ST | ||||||||
| Address2: | SUITE 280 | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757662462 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9035415455 | ||||||||
| FaxNumber: | 9035415456 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2010 | ||||||||
| LastUpdateDate: | 06/03/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 712611 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.