Healthcare Provider Details

I. General information

NPI: 1801816780
Provider Name (Legal Business Name): JAN L CAMPBELL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 06/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF KANSAS MEDICAL CTR 3901 RAINBOW BLVD, MS 4015
KANSAS CITY KS
66160-0001
US

IV. Provider business mailing address

UNIVERSITY OF KANSAS MEDICAL CTR 3901 RAINBOW BLVD, MS 4015
KANSAS CITY KS
66160-0001
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-6493
  • Fax: 913-588-6414
Mailing address:
  • Phone: 913-588-6493
  • Fax: 913-588-6414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number04-26766
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number21528
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberR5H10
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: