Provider Demographics
NPI:1922513142
Name:CAMACHO, HERLLY YOHANNA (ARNP)
Entity Type:Individual
Prefix:
First Name:HERLLY
Middle Name:YOHANNA
Last Name:CAMACHO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-3742
Mailing Address - Country:US
Mailing Address - Phone:307-514-9888
Mailing Address - Fax:
Practice Address - Street 1:4140 S POPLAR ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-6104
Practice Address - Country:US
Practice Address - Phone:307-235-4143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-11
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9428927363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily