Provider Demographics
NPI:1952933970
Name:SPERDUTO, KAMERON ANSLEY (CPNP)
Entity Type:Individual
Prefix:
First Name:KAMERON
Middle Name:ANSLEY
Last Name:SPERDUTO
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 WEST ILLINOIS AVENUE
Mailing Address - Street 2:ATTN: MELANIE GODFREY
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387
Mailing Address - Country:US
Mailing Address - Phone:910-692-2444
Mailing Address - Fax:
Practice Address - Street 1:195 WEST ILLINOIS AVENUE
Practice Address - Street 2:ATTN: MELANIE GODFREY
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387
Practice Address - Country:US
Practice Address - Phone:910-692-2444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-07
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5012829363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC202016283OtherNC PEDIATRIC NURSING CERTIFICATION BOARD