Healthcare Provider Details

I. General information

NPI: 1003185042
Provider Name (Legal Business Name): JENNIFER LYNN CAMPBELL ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2011
Last Update Date: 12/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5323 HARRY HINES BLVD SUITE HA9.134
DALLAS TX
75390-8879
US

IV. Provider business mailing address

3948 CHEVY CHASE LN
FRISCO TX
75033-4451
US

V. Phone/Fax

Practice location:
  • Phone: 214-645-7700
  • Fax:
Mailing address:
  • Phone: 225-405-0862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number798666
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: