Provider Demographics
NPI:1053635391
Name:CAMERON, TRACI (NP)
Entity Type:Individual
Prefix:MRS
First Name:TRACI
Middle Name:
Last Name:CAMERON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 TURTLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-1947
Mailing Address - Country:US
Mailing Address - Phone:903-596-3588
Mailing Address - Fax:903-594-2038
Practice Address - Street 1:203 NACOGDOCHES ST
Practice Address - Street 2:SUITE 280
Practice Address - City:JACKSONVILLE
Practice Address - State:TX
Practice Address - Zip Code:75766-2462
Practice Address - Country:US
Practice Address - Phone:903-541-5455
Practice Address - Fax:903-541-5456
Is Sole Proprietor?:No
Enumeration Date:2010-03-16
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX712611363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner