Provider Demographics
NPI:1609060862
Name:BERTUS, CAMI ANN (PA)
Entity Type:Individual
Prefix:
First Name:CAMI
Middle Name:ANN
Last Name:BERTUS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CAMI
Other - Middle Name:ANN
Other - Last Name:NEAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:380 WOODS COVE RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35768-2428
Mailing Address - Country:US
Mailing Address - Phone:256-259-4444
Mailing Address - Fax:
Practice Address - Street 1:380 WOODS COVE RD
Practice Address - Street 2:
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35768-2428
Practice Address - Country:US
Practice Address - Phone:256-259-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA1375363A00000X
ALPA.772363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALPA.772OtherLICENSE
TNPA1375OtherLICENSE
AL158202Medicaid
AL511-46004OtherBLUE CROSS/BLUE SHIELD OF ALABAMA
AL772-4235OtherQACSC
AL7203722930OtherDOT NATIONAL REGISTRY
AL772-4235OtherLPSP
AL772-4235OtherLPSP