Provider Demographics
NPI:1073905972
Name:ALLRED, CAMILLE WILLMORE (FNP-C)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:WILLMORE
Last Name:ALLRED
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 E 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-2518
Mailing Address - Country:US
Mailing Address - Phone:801-592-1993
Mailing Address - Fax:
Practice Address - Street 1:222 E 7TH AVE
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84103-2518
Practice Address - Country:US
Practice Address - Phone:801-592-1993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-02
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7863784-8900363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily