Healthcare Provider Details

I. General information

NPI: 1396913828
Provider Name (Legal Business Name): KIRSTIN LEE CAMPBELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIRSTIN ABEL LEE M.D.

II. Dates (important events)

Enumeration Date: 02/19/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 ASHLEY AVE
CHARLESTON SC
29425-1002
US

IV. Provider business mailing address

PO BOX 751461
CHARLOTTE NC
28275-1461
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-1414
  • Fax:
Mailing address:
  • Phone: 843-792-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2009007998
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number2009007998
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number51414
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: