Healthcare Provider Details

I. General information

NPI: 1366882417
Provider Name (Legal Business Name): CAROL D CAMPBELL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2013
Last Update Date: 07/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 W HIGH ST
SHERIDAN AR
72150-2118
US

IV. Provider business mailing address

211 W HIGH ST
SHERIDAN AR
72150-2118
US

V. Phone/Fax

Practice location:
  • Phone: 870-942-5610
  • Fax: 870-942-2672
Mailing address:
  • Phone: 870-942-5610
  • Fax: 870-942-2672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberA003778
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberS001114
License Number StateAR

VIII. Authorized Official

Name: CAROL D CAMPBELL
Title or Position: OWNER
Credential: APN
Phone: 870-942-5610