Healthcare Provider Details

I. General information

NPI: 1447856471
Provider Name (Legal Business Name): HALIE KAITLYN KEMMLING-CAMPBELL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2020
Last Update Date: 05/25/2022
Certification Date: 05/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

699 S MAIN ST
CANANDAIGUA NY
14424-2208
US

IV. Provider business mailing address

699 S MAIN ST
CANANDAIGUA NY
14424-2208
US

V. Phone/Fax

Practice location:
  • Phone: 585-978-8240
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: