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General NPI Number Information
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NPI Number | 1942937826
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Entity Type | Individual
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Provider Name | MR. TYLER MICHAEL CAMPBELL
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Gender | Male
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Dates
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Enumeration Date | 08/02/2022
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Last Update Date | 08/02/2022
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Provider Practice Location Address
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Address Line | 1701 S BROADWAY ST
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City | PITTSBURG
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State | KS
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Zip | 66762-7500
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Country | US
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Telephone | 417-262-3637
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Fax |
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Provider Business Mailing Address
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Address Line | 206 W 2ND ST
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City | LAMAR
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State | MO
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Zip | 64759-1031
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Country | US
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Telephone | 417-262-3637
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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 | 24-01618
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License Number State | KS
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