Provider Demographics
NPI:1720248867
Name:WILLIBY, CAMERON ZOEANN (ARNP)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:ZOEANN
Last Name:WILLIBY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:CAMERON
Other - Middle Name:ZOEANN
Other - Last Name:DICKINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:105 W 13TH ST
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-3613
Mailing Address - Country:US
Mailing Address - Phone:785-621-4990
Mailing Address - Fax:
Practice Address - Street 1:105 W 13TH ST
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-3613
Practice Address - Country:US
Practice Address - Phone:785-621-4990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS46205363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner