Healthcare Provider Details

I. General information

NPI: 1891505863
Provider Name (Legal Business Name): HEATHER ANN CAMPBELL PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2025
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5348 LAMME RD
MORAINE OH
45439-3215
US

IV. Provider business mailing address

5348 LAMME RD
MORAINE OH
45439-3215
US

V. Phone/Fax

Practice location:
  • Phone: 391-534-4651
  • Fax: 937-522-8799
Mailing address:
  • Phone: 937-534-4651
  • Fax: 937-522-8799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0037133
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0037133
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: