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General NPI Number Information
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NPI Number | 1326867508
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Entity Type | Individual
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Provider Name | BRYCE CAMPBELL CHILD FNP-C
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Gender | Male
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Dates
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Enumeration Date | 10/07/2024
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | 2530 E SOUTHERN AVE
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City | MESA
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State | AZ
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Zip | 85204-5411
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Country | US
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Telephone | 480-834-4188
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Fax |
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Provider Business Mailing Address
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Address Line | 10200 GRAND CENTRAL AVE STE 220
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City | OWINGS MILLS
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State | MD
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Zip | 21117-4366
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 10634634-4405
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License Number State | UT
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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 | 317451
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License Number State | AZ
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