Healthcare Provider Details

I. General information

NPI: 1316978752
Provider Name (Legal Business Name): CAROLYN SUE CAMPBELL II CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1227 US RTE 22 SOUTH WEST
WASHINGTON CH OH
43160
US

IV. Provider business mailing address

1145 STORYBROOK DR
WASHINGTON COURT HOUSE OH
43160-2602
US

V. Phone/Fax

Practice location:
  • Phone: 740-333-3310
  • Fax: 740-333-3310
Mailing address:
  • Phone: 740-335-3892
  • Fax: 740-335-5395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP-04143
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP-04143
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: