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NPI Code Detail

MEDICARE: MRS. MIKAYLA LEE CAMPBELL CRNA

MEDICARE: MRS. MIKAYLA LEE CAMPBELL CRNA
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
1367500000XCertified Registered Nurse Anesthetist1135184TX

General Provider Information

NPI Number : 1467143404
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MIKAYLA LEE CAMPBELL CRNA
Provider Business Mailing Address
First Line : 3700 LINDEN AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76107-4544
Country : US
Telephone Number : 281-786-7510
Fax Number :
Provider Business Practice Location Address
First Line : 1500 S MAIN ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-4917
Country : US
Telephone Number : 817-702-3431
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/19/2023
Last Update Date : 03/05/2026

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