Provider Demographics
NPI:1033170006
Name:CAMPBELL, LORRIE L (DO)
Entity Type:Individual
Prefix:
First Name:LORRIE
Middle Name:L
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LORRIE
Other - Middle Name:LYNETTE
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 843966
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3966
Mailing Address - Country:US
Mailing Address - Phone:573-884-3300
Mailing Address - Fax:573-884-0943
Practice Address - Street 1:1014 MADISON ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65101-3458
Practice Address - Country:US
Practice Address - Phone:573-644-6999
Practice Address - Fax:573-644-7880
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001008532207Q00000X
KS05-29802207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100422870 AMedicaid
102198Medicare ID - Type Unspecified
KS100422870 AMedicaid