Provider Demographics
NPI:1487347837
Name:POULLARD, KAMERYN (MSW)
Entity type:Individual
Prefix:
First Name:KAMERYN
Middle Name:
Last Name:POULLARD
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MRS
Other - First Name:KAMERYN
Other - Middle Name:
Other - Last Name:SAMPSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6230 EL GRANATE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77048-4074
Mailing Address - Country:US
Mailing Address - Phone:858-663-8899
Mailing Address - Fax:
Practice Address - Street 1:1317 EDGEWATER DR STE 2019
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-6350
Practice Address - Country:US
Practice Address - Phone:858-663-8899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula