Provider Demographics
NPI:1134274939
Name:GARRETT, CAMERON-K (RXN, CNS)
Entity type:Individual
Prefix:MS
First Name:CAMERON-K
Middle Name:
Last Name:GARRETT
Suffix:
Gender:F
Credentials:RXN, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7010 BROADWAY STE 210
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80221-2921
Mailing Address - Country:US
Mailing Address - Phone:303-650-1070
Mailing Address - Fax:303-650-5970
Practice Address - Street 1:7010 BROADWAY STE 210
Practice Address - Street 2:SUITE 210
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80221-2921
Practice Address - Country:US
Practice Address - Phone:303-650-1070
Practice Address - Fax:303-650-5970
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0048939364SP0809X
CO0000381364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO204330472OtherTAX ID