Healthcare Provider Details

I. General information

NPI: 1831751650
Provider Name (Legal Business Name): KAITLIN ELIZABETH CAMPBELL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KAITLIN E TEICHMAN FNP

II. Dates (important events)

Enumeration Date: 07/01/2019
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1149 LINCOLN WAY E
MASSILLON OH
44646-6950
US

IV. Provider business mailing address

1149 LINCOLN WAY E
MASSILLON OH
44646-6950
US

V. Phone/Fax

Practice location:
  • Phone: 330-830-7900
  • Fax:
Mailing address:
  • Phone: 616-822-6890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704348107
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0040775
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: