MEDICARE: MRS. HEDY K CAMPOS PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	0024168053	VA

General Provider Information

NPI Number	:	1023261195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HEDY K CAMPOS PMHNP-BC

Provider Business Mailing Address
First Line	:	38 NOEL DRIVE
Second Line	:
City	:	FREDERICKSBURG
State	:	VA
Zip	:	22408-5515
Country	:	US
Telephone Number	:	540-604-0529
Fax Number	:

Provider Business Practice Location Address
First Line	:	4701 SPOTSYLVANIA PKWY
Second Line	:	STE 101
City	:	FREDERICKSBURG
State	:	VA
Zip	:	22407-9435
Country	:	US
Telephone Number	:	540-371-3753
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2008
Last Update Date	:	09/26/2019

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