Healthcare Provider Details

I. General information

NPI: 1922165695
Provider Name (Legal Business Name): JENNIFER D CAMPBELL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 10/12/2020
Certification Date: 10/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1307 FEDERAL ST SECOND FLOOR
PITTSBURGH PA
15212-4769
US

IV. Provider business mailing address

1307 FEDERAL ST SECOND FLOOR
PITTSBURGH PA
15212-4769
US

V. Phone/Fax

Practice location:
  • Phone: 877-660-6777
  • Fax: 412-359-8055
Mailing address:
  • Phone: 877-660-6777
  • Fax: 412-359-8055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA052658
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: