Provider Demographics
NPI:1740801778
Name:MCCALLISTER, CAMMIE (CNA)
Entity Type:Individual
Prefix:
First Name:CAMMIE
Middle Name:
Last Name:MCCALLISTER
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 MORNINGSIDE PARK
Mailing Address - Street 2:
Mailing Address - City:LA FOLLETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37766-2836
Mailing Address - Country:US
Mailing Address - Phone:548-643-1656
Mailing Address - Fax:
Practice Address - Street 1:118 MORNINGSIDE PARK
Practice Address - Street 2:
Practice Address - City:LA FOLLETTE
Practice Address - State:TN
Practice Address - Zip Code:37766-2836
Practice Address - Country:US
Practice Address - Phone:548-643-1656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0016881376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide