Provider Demographics
NPI:1629210661
Name:CAMPBELL, REBECCA (RD, RN)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:RD, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3102 BRYKERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-1306
Mailing Address - Country:US
Mailing Address - Phone:254-774-1395
Mailing Address - Fax:
Practice Address - Street 1:1901 S. 1ST ST
Practice Address - Street 2:CENTRAL TEXAS VETERANS HEALTHCARE SYSTEM
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504
Practice Address - Country:US
Practice Address - Phone:254-743-1304
Practice Address - Fax:254-743-0106
Is Sole Proprietor?:No
Enumeration Date:2009-04-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN603341133V00000X
TX740897163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No163W00000XNursing Service ProvidersRegistered Nurse