Healthcare Provider Details

I. General information

NPI: 1851249379
Provider Name (Legal Business Name): ALEXIS CAMPBELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2026
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 N WESTWOOD BLVD
POPLAR BLUFF MO
63901-3396
US

IV. Provider business mailing address

3100 OAK GROVE RD
POPLAR BLUFF MO
63901-1573
US

V. Phone/Fax

Practice location:
  • Phone: 573-686-8399
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2026007268
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: