Provider Demographics
NPI:1548686033
Name:BROOME, CAMILLE ELIZABETH (PA, MPH)
Entity type:Individual
Prefix:
First Name:CAMILLE
Middle Name:ELIZABETH
Last Name:BROOME
Suffix:
Gender:F
Credentials:PA, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 604333
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-4333
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:264 THETFORD ST STE 120
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-5065
Practice Address - Country:US
Practice Address - Phone:828-378-5620
Practice Address - Fax:828-378-5629
Is Sole Proprietor?:No
Enumeration Date:2014-03-09
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.200696363A00000X
NC0010-12286363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00277559Medicaid
LA2366084Medicaid
LA2366084Medicaid