Healthcare Provider Details

I. General information

NPI: 1306762216
Provider Name (Legal Business Name): SHEILA ROCHELLE KENNEDY CAMPBELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 SUSAN CT
RADCLIFF KY
40160-8809
US

IV. Provider business mailing address

156 SUSAN CT
RADCLIFF KY
40160-8809
US

V. Phone/Fax

Practice location:
  • Phone: 270-319-1605
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number1132720
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: