Healthcare Provider Details

I. General information

NPI: 1992257232
Provider Name (Legal Business Name): DIANA ELIZABETH CAMPBELL PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2016
Last Update Date: 11/22/2025
Certification Date: 11/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3610 BUSH ST
RALEIGH NC
27609-7511
US

IV. Provider business mailing address

2326 GLASCOCK ST
RALEIGH NC
27610-1602
US

V. Phone/Fax

Practice location:
  • Phone: 919-876-3130
  • Fax: 919-876-3134
Mailing address:
  • Phone: 203-528-5447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number6786
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5010155
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number6786
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: