Provider Demographics
NPI:1245582550
Name:CAMPBELL, KIMBERLY RUSHANNA (FNP-C)
Entity Type:Individual
Prefix:MISS
First Name:KIMBERLY
Middle Name:RUSHANNA
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4160 EDSON AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-2012
Mailing Address - Country:US
Mailing Address - Phone:607-221-2942
Mailing Address - Fax:
Practice Address - Street 1:4160 EDSON AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-2012
Practice Address - Country:US
Practice Address - Phone:607-221-2942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-10
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33 337558363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily