Provider Demographics
NPI:1194019422
Name:KAMPSCHMIDT, JOHN DAVID (NP)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DAVID
Last Name:KAMPSCHMIDT
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 W SHIELDS AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93705
Mailing Address - Country:US
Mailing Address - Phone:559-225-4706
Mailing Address - Fax:559-225-4710
Practice Address - Street 1:199 W SHIELDS AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93705
Practice Address - Country:US
Practice Address - Phone:559-225-4706
Practice Address - Fax:559-225-4710
Is Sole Proprietor?:No
Enumeration Date:2011-06-03
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19147363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA19147OtherNURSE PRACTITIONER