Healthcare Provider Details

I. General information

NPI: 1821361650
Provider Name (Legal Business Name): CHARISSA M KAMPS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2012
Last Update Date: 09/14/2021
Certification Date: 09/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3870 W RIVER RD STE 126
TUCSON AZ
85741-3080
US

IV. Provider business mailing address

3870 W RIVER RD STE 126
TUCSON AZ
85741-3080
US

V. Phone/Fax

Practice location:
  • Phone: 520-219-6616
  • Fax: 520-742-6187
Mailing address:
  • Phone: 520-219-6616
  • Fax: 520-742-6187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN113854
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP4219
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: