Provider Demographics
NPI:1265026090
Name:CAMPBELL, KELSEY GAINEY (LPN)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:GAINEY
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 ROOSEVELT DR
Mailing Address - Street 2:
Mailing Address - City:EUTAWVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29048-8744
Mailing Address - Country:US
Mailing Address - Phone:843-499-2608
Mailing Address - Fax:
Practice Address - Street 1:234 ROOSEVELT DR
Practice Address - Street 2:
Practice Address - City:EUTAWVILLE
Practice Address - State:SC
Practice Address - Zip Code:29048-8744
Practice Address - Country:US
Practice Address - Phone:843-499-2608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC51404164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse