Healthcare Provider Details

I. General information

NPI: 1689990772
Provider Name (Legal Business Name): MICHELLE CAMPBELL-THOMAS PMHNP-BC,APCNP,APRN,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2010
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 10052
WESTBURY NY
11590-0801
US

IV. Provider business mailing address

PO BOX 10052
WESTBURY NY
11590-0801
US

V. Phone/Fax

Practice location:
  • Phone: 516-414-2604
  • Fax:
Mailing address:
  • Phone: 516-414-2604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number590150
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number406854
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number309138
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: