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General NPI Number Information
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NPI Number | 1093492977
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Entity Type | Individual
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Provider Name | BRIAN PATRICK CAMPBELL MS, LAT, ATC
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Gender | Male
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Dates
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Enumeration Date | 07/03/2023
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Last Update Date | 09/18/2023
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Provider Practice Location Address
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Address Line | 650 JOEL DR
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City | FORT CAMPBELL
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State | KY
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Zip | 42223-5318
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Country | US
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Telephone | 720-635-3932
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Fax |
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Provider Business Mailing Address
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Address Line | 75 E VETERANS DR APT O103
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City | COOKEVILLE
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State | TN
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Zip | 38501-5242
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 0000003007
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License Number State | TN
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