Healthcare Provider Details

I. General information

NPI: 1225337348
Provider Name (Legal Business Name): JENNIFER LEIGH CAMPBELL R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2011
Last Update Date: 03/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

372 GREENO RD S
FAIRHOPE AL
36532-1916
US

IV. Provider business mailing address

51760 US HIGHWAY 31
BAY MINETTE AL
36507-7670
US

V. Phone/Fax

Practice location:
  • Phone: 251-928-2871
  • Fax:
Mailing address:
  • Phone: 251-379-4615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-128182
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: