Healthcare Provider Details

I. General information

NPI: 1548242894
Provider Name (Legal Business Name): CAROLINE ELIZABETH CAMPBELL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 N BUSINESS ROUTE 5
CAMDENTON MO
65020-2659
US

IV. Provider business mailing address

1930 N BUSINESS ROUTE 5
CAMDENTON MO
65020-2659
US

V. Phone/Fax

Practice location:
  • Phone: 573-346-5624
  • Fax: 573-346-1957
Mailing address:
  • Phone: 573-346-5624
  • Fax: 573-346-1957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number113713
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: