Provider Demographics
NPI:1619497831
Name:CAMPBELL, ERICA AMY (DO)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:AMY
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4440 BROADWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-3315
Mailing Address - Country:US
Mailing Address - Phone:816-384-2825
Mailing Address - Fax:816-753-2671
Practice Address - Street 1:4440 BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-3315
Practice Address - Country:US
Practice Address - Phone:816-384-2825
Practice Address - Fax:816-753-2671
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-20
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017020330207R00000X
MO2020032471207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine