Healthcare Provider Details

I. General information

NPI: 1639699630
Provider Name (Legal Business Name): ANDREA CAMPBELL-KAMARA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 07/18/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7139 8197 WESTSIDE BLVD
FULTON MD
20759-3016
US

IV. Provider business mailing address

7139 8197 WESTSIDE BLVD
FULTON MD
20759
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax:
Mailing address:
  • Phone: 866-389-2727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR220944
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: