Provider Demographics
NPI:1225817257
Name:CAMPBELL, AMANDA KRISTEN (AGACNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:KRISTEN
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15505 BRITLEY RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-5952
Mailing Address - Country:US
Mailing Address - Phone:704-962-2770
Mailing Address - Fax:
Practice Address - Street 1:100 MEDICAL PARK DR STE 210
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2966
Practice Address - Country:US
Practice Address - Phone:704-403-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-28
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCAMP-ZI5XS363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care