Provider Demographics
NPI:1356807721
Name:CAMERON, JENNA LEE (NP)
Entity type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:LEE
Last Name:CAMERON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10226 COULOAK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-7688
Mailing Address - Country:US
Mailing Address - Phone:704-801-7380
Mailing Address - Fax:
Practice Address - Street 1:10226 COULOAK DR STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-7688
Practice Address - Country:US
Practice Address - Phone:048-017-3807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-11
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCAME-PF4PU9363LF0000X
NC5011478363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily