Provider Demographics
NPI:1215553649
Name:CAMPBELL, KERRY-ANN NICOLE
Entity Type:Individual
Prefix:MRS
First Name:KERRY-ANN
Middle Name:NICOLE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1546 RIVERVIEW RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-4011
Mailing Address - Country:US
Mailing Address - Phone:678-458-6270
Mailing Address - Fax:
Practice Address - Street 1:1546 RIVERVIEW RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-4011
Practice Address - Country:US
Practice Address - Phone:678-458-6270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-22
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN262602163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health