Healthcare Provider Details

I. General information

NPI: 1508889049
Provider Name (Legal Business Name): KAREN D CAMPBELL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAREN D HURD

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 02/14/2020
Certification Date: 02/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23400 US HIGHWAY 160
WALSENBURG CO
81089-8100
US

IV. Provider business mailing address

23400 US HIGHWAY 160
WALSENBURG CO
81089-8100
US

V. Phone/Fax

Practice location:
  • Phone: 719-738-4590
  • Fax: 719-738-4553
Mailing address:
  • Phone: 719-738-4590
  • Fax: 719-738-4553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0003829-NP
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number62851
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: