Provider Demographics
NPI:1477933976
Name:CAMPBELL, KEVIN DION (CRNP)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:DION
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2828 HIGHWAY 31 S STE 107
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35603-1538
Mailing Address - Country:US
Mailing Address - Phone:256-351-8870
Mailing Address - Fax:256-351-0599
Practice Address - Street 1:2828 HIGHWAY 31 S STE 107
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603-1538
Practice Address - Country:US
Practice Address - Phone:256-351-8870
Practice Address - Fax:256-351-0599
Is Sole Proprietor?:No
Enumeration Date:2015-06-01
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-112004363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL101I506121Medicare PIN