MEDICARE: MRS. CAROL A CAMPBELL CRNP

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	363LF0000X	Family Nurse Practitioner	0024167891	VA
2	363LA2200X	Adult Health Nurse Practitioner	R110480	MD

General Provider Information

NPI Number	:	1053366252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAROL A CAMPBELL CRNP

Provider Business Mailing Address
First Line	:	102 WEST BROADDUS AVE
Second Line	:	SUITE 200
City	:	BOWLING GREEN
State	:	VA
Zip	:	22427-1596
Country	:	US
Telephone Number	:	804-632-1030
Fax Number	:	804-632-1033

Provider Business Practice Location Address
First Line	:	102 WEST BROADDUS AVE STE 200
Second Line	:	SUITE 200
City	:	BOWLING GREEN
State	:	VA
Zip	:	22427-2242
Country	:	US
Telephone Number	:	804-632-1030
Fax Number	:	804-632-1033

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

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	04/03/2024

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