Provider Demographics
NPI:1447579727
Name:CAMPBELL, CRYSTAL D (PA-C)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:D
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 1:3815 FABER STREET
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405-7511
Mailing Address - Country:US
Mailing Address - Phone:843-767-9312
Mailing Address - Fax:843-767-9313
Practice Address - Street 1:3815 FABER PLACE DR
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-8533
Practice Address - Country:US
Practice Address - Phone:843-767-9312
Practice Address - Fax:843-767-9313
Is Sole Proprietor?:No
Enumeration Date:2010-05-25
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-02524363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant