Healthcare Provider Details

I. General information

NPI: 1457255812
Provider Name (Legal Business Name): ELIZABETH CAMPBELL PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 CRAIG RD STE 200
SAINT LOUIS MO
63141-7190
US

IV. Provider business mailing address

129 PLEASANT RIDGE DR
EDWARDSVILLE IL
62025-3328
US

V. Phone/Fax

Practice location:
  • Phone: 314-776-7999
  • Fax: 314-772-2257
Mailing address:
  • Phone: 314-728-1462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2026045482
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: