Provider Demographics
NPI:1518590553
Name:JOHNSON, CAMEO ELIZABETH (PMHNP)
Entity Type:Individual
Prefix:
First Name:CAMEO
Middle Name:ELIZABETH
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 E QUARTZ RD
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86005-7093
Mailing Address - Country:US
Mailing Address - Phone:928-243-0244
Mailing Address - Fax:
Practice Address - Street 1:2030 W BASELINE RD # 182-8355
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041-6574
Practice Address - Country:US
Practice Address - Phone:928-235-2927
Practice Address - Fax:928-268-0289
Is Sole Proprietor?:No
Enumeration Date:2020-02-18
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ238464363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health