Provider Demographics
NPI:1396209201
Name:CAMPBELL, DAVID ANDREW (NP,BC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ANDREW
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:NP,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 BALD EAGLE WAY
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-4022
Mailing Address - Country:US
Mailing Address - Phone:913-702-4029
Mailing Address - Fax:
Practice Address - Street 1:421 MUNCIE TER
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-5025
Practice Address - Country:US
Practice Address - Phone:913-702-4029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS45685363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health