Provider Demographics
NPI:1518335215
Name:CAMPBELL, DERRICK BARRINGTON (LPN)
Entity Type:Individual
Prefix:MR
First Name:DERRICK
Middle Name:BARRINGTON
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 E 220TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-5312
Mailing Address - Country:US
Mailing Address - Phone:347-822-8151
Mailing Address - Fax:
Practice Address - Street 1:830 E 220TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-5312
Practice Address - Country:US
Practice Address - Phone:347-822-8151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-11
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY290411-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse