Provider Demographics
NPI:1306379763
Name:KIOKO-CAMPBELL, SUSAN
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:KIOKO-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:PO BOX 875743
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64187-5743
Mailing Address - Country:US
Mailing Address - Phone:913-215-5008
Mailing Address - Fax:816-447-3960
Practice Address - Street 1:10977 GRANADA LN
Practice Address - Street 2:SUITE 105
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-1468
Practice Address - Country:US
Practice Address - Phone:913-215-5008
Practice Address - Fax:816-447-3960
Is Sole Proprietor?:No
Enumeration Date:2017-04-04
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-77508363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner