Healthcare Provider Details

I. General information

NPI: 1174512347
Provider Name (Legal Business Name): STEPHANIA KAY CAMPBELL TIMOTHY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 03/12/2021
Certification Date: 03/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 N NEVADA AVE
COLORADO SPRINGS CO
80907-6819
US

IV. Provider business mailing address

711 N TAYLOR ST
GUNNISON CO
81230-2296
US

V. Phone/Fax

Practice location:
  • Phone: 719-776-8040
  • Fax: 719-776-6820
Mailing address:
  • Phone: 970-641-1456
  • Fax: 970-641-4461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD00047323
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberDR.0040596
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: