Healthcare Provider Details

I. General information

NPI: 1275813719
Provider Name (Legal Business Name): KELLY ELIZABETH CAMPBELL-WIGINGTON PMHNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2011
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 W 27TH ST RM 5S
NEW YORK NY
10001-6208
US

IV. Provider business mailing address

7890 LAKE SAWGRASS LOOP
FORT MYERS FL
33907-6640
US

V. Phone/Fax

Practice location:
  • Phone: 888-815-3583
  • Fax:
Mailing address:
  • Phone: 239-560-2179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3076452
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN3076452
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: