Basic Information
| Provider Information | |||||||||
| NPI: | 1457809477 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAMERON | ||||||||
| FirstName: | ASHLEY | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7032 S SORRENTO WAY | ||||||||
| Address2: | |||||||||
| City: | WEST JORDAN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840818184 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8014146231 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10462 S REDWOOD RD | ||||||||
| Address2: | |||||||||
| City: | SOUTH JORDAN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840958501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8012601919 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2016 | ||||||||
| LastUpdateDate: | 09/19/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 6291177-1206 | UT | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AS0400X | 6291177-1206 | UT | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.