Provider Demographics
NPI:1083040943
Name:CAMPBELL, COURTNEY MORGAN (PA-C)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:MORGAN
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5820 YOLANDA AVE
Mailing Address - Street 2:APT 16
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-1448
Mailing Address - Country:US
Mailing Address - Phone:316-640-5708
Mailing Address - Fax:
Practice Address - Street 1:16030 VENTURA BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2731
Practice Address - Country:US
Practice Address - Phone:818-981-3688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-23
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA23213363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA23213OtherLICENSE