Healthcare Provider Details

I. General information

NPI: 1669885240
Provider Name (Legal Business Name): PATRICK A. CAMPBELL CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2014
Last Update Date: 12/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 22ND AVE
KEARNEY NE
68845-2206
US

IV. Provider business mailing address

6420 56TH AVE
KEARNEY NE
68845-0380
US

V. Phone/Fax

Practice location:
  • Phone: 308-455-3600
  • Fax: 877-631-0816
Mailing address:
  • Phone: 308-224-2062
  • Fax: 877-631-0816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number68522
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number101257
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: