Healthcare Provider Details

I. General information

NPI: 1144294646
Provider Name (Legal Business Name): GERALDINE G. CAMPBELL APRN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 06/04/2021
Certification Date: 06/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 W MAIN ST
MARVELL AR
72366-9486
US

IV. Provider business mailing address

900 N 7TH ST
WEST MEMPHIS AR
72301-2001
US

V. Phone/Fax

Practice location:
  • Phone: 870-829-1194
  • Fax: 870-407-5037
Mailing address:
  • Phone: 870-735-3842
  • Fax: 870-394-4817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA01469
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: