Healthcare Provider Details

I. General information

NPI: 1992849780
Provider Name (Legal Business Name): MR. KEVIN SCOTT CAMPBELL SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 01/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

722 LOUISIANA AVE
BOGALUSA LA
70427
US

IV. Provider business mailing address

722 LOUISIANA AVE
BOGALUSA LA
70427
US

V. Phone/Fax

Practice location:
  • Phone: 985-730-4357
  • Fax: 985-730-5267
Mailing address:
  • Phone: 985-730-4357
  • Fax: 985-730-5267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: