Healthcare Provider Details

I. General information

NPI: 1023834074
Provider Name (Legal Business Name): JAMIE LEE CAMPBELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2024
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 OLD CLINE RD
GHENT WV
25843-9349
US

IV. Provider business mailing address

205 OLD CLINE RD
GHENT WV
25843-9349
US

V. Phone/Fax

Practice location:
  • Phone: 304-890-1143
  • Fax:
Mailing address:
  • Phone: 304-890-1143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: