Provider Demographics
NPI:1265779094
Name:CAMPER, YVONNE DANAE
Entity type:Individual
Prefix:MS
First Name:YVONNE
Middle Name:DANAE
Last Name:CAMPER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:YVONNE
Other - Middle Name:DANAE
Other - Last Name:CAMPER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:126 BETH HARRINGTON LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT OLIVE
Mailing Address - State:MS
Mailing Address - Zip Code:39119-5347
Mailing Address - Country:US
Mailing Address - Phone:601-797-9647
Mailing Address - Fax:
Practice Address - Street 1:303 ELLIS ST
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MS
Practice Address - Zip Code:39051-3808
Practice Address - Country:US
Practice Address - Phone:601-855-5287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR863399363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily