Provider Demographics
NPI:1174370118
Name:BANKHEAD, CAMILLE J (FNP-C)
Entity type:Individual
Prefix:
First Name:CAMILLE
Middle Name:J
Last Name:BANKHEAD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:CAMILLE
Other - Middle Name:J
Other - Last Name:VERNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:832 E THREE FOUNTAINS DR UNIT 186
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-5254
Mailing Address - Country:US
Mailing Address - Phone:801-707-0900
Mailing Address - Fax:
Practice Address - Street 1:832 E THREE FOUNTAINS DR UNIT 186
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5254
Practice Address - Country:US
Practice Address - Phone:801-707-0900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7473051-8900363LF0000X
UT7473051-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily