Provider Demographics
NPI:1518343276
Name:HAMMACK, CAMERON D (APRN)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:D
Last Name:HAMMACK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 N MAIN ST
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-9007
Mailing Address - Country:US
Mailing Address - Phone:270-821-6262
Mailing Address - Fax:270-821-6272
Practice Address - Street 1:2100 N MAIN ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-9007
Practice Address - Country:US
Practice Address - Phone:270-821-6262
Practice Address - Fax:270-821-6272
Is Sole Proprietor?:No
Enumeration Date:2015-08-05
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYF0815011363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily