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General NPI Number Information
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NPI Number | 1275813719
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Entity Type | Individual
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Provider Name | KELLY ELIZABETH CAMPBELL-WIGINGTON PMHNP, FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 08/27/2011
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Last Update Date | 11/11/2025
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Provider Practice Location Address
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Address Line | 607 NORTH AVE OFC 18
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City | WAKEFIELD
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State | MA
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Zip | 01880-1306
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Country | US
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Telephone | 781-705-0567
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Fax | 623-666-6792
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Provider Business Mailing Address
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Address Line | 7890 LAKE SAWGRASS LOOP
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City | FORT MYERS
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State | FL
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Zip | 33907-6640
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Country | US
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Telephone | 239-560-2179
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN3076452
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 3076452
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License Number State | FL
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