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General NPI Number Information
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NPI Number | 1992849780
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Entity Type | Individual
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Provider Name | MR. KEVIN SCOTT CAMPBELL SR.
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Gender | Male
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Dates
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Enumeration Date | 02/16/2007
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Last Update Date | 01/16/2008
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Provider Practice Location Address
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Address Line | 722 LOUISIANA AVE
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City | BOGALUSA
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State | LA
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Zip | 70427
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Country | US
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Telephone | 985-730-4357
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Fax | 985-730-5267
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Provider Business Mailing Address
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Address Line | 722 LOUISIANA AVE
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City | BOGALUSA
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State | LA
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Zip | 70427
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Country | US
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Telephone | 985-730-4357
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Fax | 985-730-5267
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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 | 224P00000X
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Taxonomy Name | Prosthetist
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License Number |
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 225000000X
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Taxonomy Name | Orthotic Fitter
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License Number |
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License Number State | LA
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Taxonomy #3
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State | LA
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