Provider Demographics
NPI:1003134966
Name:MCCAMPBELL, ALICIA RICHARDSON (CRNA)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:RICHARDSON
Last Name:MCCAMPBELL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-6632
Mailing Address - Country:US
Mailing Address - Phone:423-581-5984
Mailing Address - Fax:423-581-0984
Practice Address - Street 1:1030 RHETT CIR
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-1676
Practice Address - Country:US
Practice Address - Phone:423-312-9056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-17
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000101594390200000X
TN16110367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1031432526Medicare NSC