Healthcare Provider Details

I. General information

NPI: 1619703261
Provider Name (Legal Business Name): MARK CAMPBELL JR. DNP, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2024
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 E GUADALUPE RD STE 103
GILBERT AZ
85234-5116
US

IV. Provider business mailing address

2450 E GUADALUPE RD STE 103
GILBERT AZ
85234-5116
US

V. Phone/Fax

Practice location:
  • Phone: 602-610-1191
  • Fax: 602-835-0559
Mailing address:
  • Phone: 602-610-1191
  • Fax: 602-835-0559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number309722
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: