MEDICARE: BETH CAMPANA QBHP

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1811859101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETH CAMPANA QBHP

Provider Business Mailing Address
First Line	:	1310 W MAIN ST STE 201
Second Line	:
City	:	RUSSELLVILLE
State	:	AR
Zip	:	72801-2803
Country	:	US
Telephone Number	:	479-968-2001
Fax Number	:

Provider Business Practice Location Address
First Line	:	1560 W BEEBE CAPPS EXPY STE B
Second Line	:
City	:	SEARCY
State	:	AR
Zip	:	72143-5176
Country	:	US
Telephone Number	:	501-451-5891
Fax Number	:	501-451-5891

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

Provider Enumeration Date	:	11/25/2025
Last Update Date	:	11/25/2025

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