Healthcare Provider Details

I. General information

NPI: 1518330596
Provider Name (Legal Business Name): HILLARY R CAMPBELL PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2015
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1908 N MAIN ST
HAZARD KY
41701-2505
US

IV. Provider business mailing address

PO BOX 959
HAZARD KY
41702-0959
US

V. Phone/Fax

Practice location:
  • Phone: 606-439-2662
  • Fax:
Mailing address:
  • Phone: 606-435-2961
  • Fax: 606-435-2966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number10001962A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: