Provider Demographics
NPI:1417086828
Name:CAMPBELL, AGNES NANCY (PA-C)
Entity Type:Individual
Prefix:
First Name:AGNES NANCY
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14206 PUNTA BONAIRE DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78418-6518
Mailing Address - Country:US
Mailing Address - Phone:361-288-2356
Mailing Address - Fax:361-991-9370
Practice Address - Street 1:721 S ALISTER ST
Practice Address - Street 2:
Practice Address - City:PORT ARANSAS
Practice Address - State:TX
Practice Address - Zip Code:78373-4410
Practice Address - Country:US
Practice Address - Phone:361-749-4633
Practice Address - Fax:361-991-9370
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01929363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical