Healthcare Provider Details

I. General information

NPI: 1124284294
Provider Name (Legal Business Name): BROOK ASHLEY CAMPBELL DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. BROOK ASHLEY SANDERS

II. Dates (important events)

Enumeration Date: 07/29/2008
Last Update Date: 08/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 NORTHWEST BLUE PARKWAY
LEES SUMMIT MO
64086
US

IV. Provider business mailing address

1425 NORTHWEST BLUE PARKWAY
LEES SUMMIT MO
64086
US

V. Phone/Fax

Practice location:
  • Phone: 816-524-5600
  • Fax:
Mailing address:
  • Phone: 816-524-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number94-07052
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: