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NPI Code Detail

MEDICARE: DENA CAMPBELL

MEDICARE: DENA CAMPBELL
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
1174400000XSpecialist5075AR

General Provider Information

NPI Number : 1205205796
Entity Type Code : Individual
Provider Name (Legal Business Name) : DENA CAMPBELL
Provider Business Mailing Address
First Line : 1200 S 41ST CIR
Second Line :
City : FORT SMITH
State : AR
Zip : 72903-1827
Country : US
Telephone Number : 479-653-3024
Fax Number :
Provider Business Practice Location Address
First Line : 6108 S 31ST ST
Second Line :
City : FORT SMITH
State : AR
Zip : 72908-7555
Country : US
Telephone Number : 479-648-1107
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/15/2015
Last Update Date : 09/15/2015

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Directions to “ DENA CAMPBELL ” Practice Location

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