Provider Demographics
NPI:1922323559
Name:CAMERON, MARY LOU (FNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LOU
Last Name:CAMERON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:LOU
Other - Last Name:WARWICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:153 E BROADWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37760-2517
Mailing Address - Country:US
Mailing Address - Phone:865-475-9969
Mailing Address - Fax:
Practice Address - Street 1:1596 HIGHWAY 33 S
Practice Address - Street 2:
Practice Address - City:NEW TAZEWELL
Practice Address - State:TN
Practice Address - Zip Code:37825-7104
Practice Address - Country:US
Practice Address - Phone:423-626-8271
Practice Address - Fax:423-626-0688
Is Sole Proprietor?:No
Enumeration Date:2010-04-07
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN144877363LF0000X
TNAPN14811363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily