Provider Demographics
NPI:1609890664
Name:CAMPBELL, PAMELA DIANN (PA-C)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:DIANN
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 1:2149 WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-4538
Mailing Address - Country:US
Mailing Address - Phone:336-509-6341
Mailing Address - Fax:
Practice Address - Street 1:1638 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-3518
Practice Address - Country:US
Practice Address - Phone:336-438-2525
Practice Address - Fax:336-438-2526
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103291363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2756370Medicare ID - Type Unspecified
NCP65553Medicare UPIN