Provider Demographics
NPI:1083800809
Name:CAMERON, SCARLETT LOUISE
Entity Type:Individual
Prefix:MS
First Name:SCARLETT
Middle Name:LOUISE
Last Name:CAMERON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11500 CAMPBELL ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-3829
Mailing Address - Country:US
Mailing Address - Phone:816-941-2836
Mailing Address - Fax:816-942-4045
Practice Address - Street 1:11500 CAMPBELL ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-3829
Practice Address - Country:US
Practice Address - Phone:816-941-2836
Practice Address - Fax:816-942-4045
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-16
Last Update Date:2007-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO032810311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home