Healthcare Provider Details

I. General information

NPI: 1285108423
Provider Name (Legal Business Name): MICHAEL CAMPBELL APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2019
Last Update Date: 01/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 SUMMIT DR
CORBIN KY
40701-2746
US

IV. Provider business mailing address

57 SUMMIT DR
CORBIN KY
40701-2746
US

V. Phone/Fax

Practice location:
  • Phone: 606-528-9700
  • Fax:
Mailing address:
  • Phone: 606-528-9700
  • Fax: 606-528-8423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number3013051
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: