Provider Demographics
NPI:1073573358
Name:CAMPBELL, KIMBERLY M (ARNP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:M
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CAVENDER ST
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-1931
Mailing Address - Country:US
Mailing Address - Phone:770-253-6616
Mailing Address - Fax:770-254-6015
Practice Address - Street 1:15 CAVENDER ST
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-1931
Practice Address - Country:US
Practice Address - Phone:770-253-6616
Practice Address - Fax:770-254-6015
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN179027363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78003852Medicaid
GARN179027OtherGA NURSING LICENSE
OH2442708Medicaid
GARN179027OtherGA NURSING LICENSE
KY500022714Medicare PIN
KY78003852Medicaid