Healthcare Provider Details

I. General information

NPI: 1225426299
Provider Name (Legal Business Name): KEVIN CAMPBELL FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2014
Last Update Date: 07/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 MOUNT MERCY DR
PEWEE VALLEY KY
40056-8020
US

IV. Provider business mailing address

PO BOX 776351
CHICAGO IL
60677-6351
US

V. Phone/Fax

Practice location:
  • Phone: 502-241-8611
  • Fax: 502-241-4175
Mailing address:
  • Phone: 502-588-9490
  • Fax: 502-272-5116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3009043
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: