Provider Demographics
NPI:1619202884
Name:CAMPBELL, TERRI LISA DAVIS (FNP)
Entity Type:Individual
Prefix:
First Name:TERRI LISA
Middle Name:DAVIS
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4307 FAYETTEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-2676
Mailing Address - Country:US
Mailing Address - Phone:910-613-7441
Mailing Address - Fax:910-226-7572
Practice Address - Street 1:4307 FAYETTEVILLE RD
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2676
Practice Address - Country:US
Practice Address - Phone:910-613-7441
Practice Address - Fax:910-226-7572
Is Sole Proprietor?:No
Enumeration Date:2009-10-06
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5004517363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7005090Medicaid
NC2594599KMedicare PIN