Individual provider Active NPI

Camille Evette Dantzler, APRN-CNP, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Martinsburg, WV
National Provider Identifier
1811771207
Registry record updated Aug 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
117339 Issued in WV
Practice address
2500 Hospital Dr
Martinsburg, WV 25401-3402
Phone
(304) 264-1000
NPI assigned
Aug 24, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 117339 WV Primary

Addresses

Primary practice location

2500 Hospital Dr
Martinsburg, WV 25401-3402

Mailing address

73 Butterfly LN
Kearneysville, WV 25430-3666
Phone (214) 729-2294

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231018002704 WV Practitioner - Nurse Practitioner 6406201953 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

415 Wilson St
Martinsburg, WV 25401-3023
Phone (304) 596-2899

Merit-based Incentive Payment System (MIPS)

Final score
95.34 of 100Reported as apm
Quality
79.86
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
West Virginia University Medical Corporation CurrentSince Sep 18, 2023 Accepting new patients
West Virginia University Medical Corporation Current Accepting new patients

Locations

415 Wilson St
Martinsburg, WV 25401
Phone (304) 596-2899

2500 Hospital Dr
Martinsburg, WV 25401
Phone (304) 233-4134

1 Medical Center Dr
Morgantown, WV 26506
Phone (304) 293-4500

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1692835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692835200000",
    "number": "1811771207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "73 BUTTERFLY LN",
            "city": "KEARNEYSVILLE",
            "state": "WV",
            "postal_code": "254303666",
            "telephone_number": "214-729-2294"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 HOSPITAL DR",
            "city": "MARTINSBURG",
            "state": "WV",
            "postal_code": "254013402",
            "telephone_number": "304-264-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DANTZLER",
        "first_name": "CAMILLE",
        "middle_name": "EVETTE",
        "credential": "APRN-CNP, PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-08-24",
        "last_updated": "2023-08-24",
        "certification_date": "2023-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WV",
            "license": "117339",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Martinsburg, WV

Sources for this page

Verify at the official NPI Registry.