MEDICARE: KRISTINA T. CAMPBELL NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	R190635	MD

General Provider Information

NPI Number	:	1386726131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINA T. CAMPBELL NP

Provider Business Mailing Address
First Line	:	5415 RAPIDAN CT
Second Line	:
City	:	LOTHIAN
State	:	MD
Zip	:	20711-9673
Country	:	US
Telephone Number	:	704-408-2842
Fax Number	:

Provider Business Practice Location Address
First Line	:	5415 RAPIDAN CT
Second Line	:
City	:	LOTHIAN
State	:	MD
Zip	:	20711-9673
Country	:	US
Telephone Number	:	704-408-2842
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	01/21/2013

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