Provider Demographics
NPI:1376224246
Name:CAMMACK, VICTORIA ELAINE (APRN)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ELAINE
Last Name:CAMMACK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:ELAINE
Other - Last Name:ELAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:520 TECHWOOD DR N STE 100
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-8500
Mailing Address - Country:US
Mailing Address - Phone:859-936-9844
Mailing Address - Fax:859-236-0320
Practice Address - Street 1:110 DIAGNOSTIC DR STE B
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-6557
Practice Address - Country:US
Practice Address - Phone:502-227-3383
Practice Address - Fax:502-227-3383
Is Sole Proprietor?:No
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4004858363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily