Provider Demographics
NPI:1669716494
Name:CUNNINGHAM, KAMY JO (NP-C)
Entity type:Individual
Prefix:
First Name:KAMY
Middle Name:JO
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12032 N COPPER SPRING TRL
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85755-6541
Mailing Address - Country:US
Mailing Address - Phone:520-297-8505
Mailing Address - Fax:
Practice Address - Street 1:12032 N COPPER SPRING TRL
Practice Address - Street 2:
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85755-6541
Practice Address - Country:US
Practice Address - Phone:520-297-8505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTAP4746363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily