Provider Demographics
NPI:1427554401
Name:CAMPBELL, REBEKAH (PA)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:REBEKAH
Other - Middle Name:
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:5410 WHISTLING STRAITS
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-8765
Mailing Address - Country:US
Mailing Address - Phone:501-215-6370
Mailing Address - Fax:
Practice Address - Street 1:5410 WHISTLING STRAITS
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-8765
Practice Address - Country:US
Practice Address - Phone:501-215-6370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-30
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT2018-018363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant