Provider Demographics
NPI:1245590074
Name:CAMPBELL, KELLEY RENEE (RN, FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:KELLEY
Middle Name:RENEE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:RN, FNP-BC
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Mailing Address - Street 1:1 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-6722
Mailing Address - Country:US
Mailing Address - Phone:618-463-7474
Mailing Address - Fax:618-463-7543
Practice Address - Street 1:1 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-6722
Practice Address - Country:US
Practice Address - Phone:618-463-7474
Practice Address - Fax:618-463-7543
Is Sole Proprietor?:No
Enumeration Date:2012-05-27
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL209009568363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner