Provider Demographics
NPI:1437596400
Name:CAMERON, KELLY MARIE (DPT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:MARIE
Last Name:CAMERON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7954 CAYMAN CIR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-8966
Mailing Address - Country:US
Mailing Address - Phone:402-618-1360
Mailing Address - Fax:
Practice Address - Street 1:7954 CAYMAN CIR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-8966
Practice Address - Country:US
Practice Address - Phone:402-618-1360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-30
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2363225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025895900Medicaid
NE10025896000Medicaid
NE099099188Medicare PIN
NE10025941700Medicaid
NE10025896100Medicaid
NE10026445500Medicaid
IA1437596400Medicaid
NE10026056700Medicaid
NE10026252200Medicaid