Provider Demographics
NPI:1649385857
Name:CAMPBELL, KATHLEEN K (RPA-C)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:K
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
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Mailing Address - Street 1:711 TROY SCHENECTADY RD STE 203
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2461
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:2125 RIVER RD
Practice Address - Street 2:SUITE 202
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12309-1135
Practice Address - Country:US
Practice Address - Phone:518-346-9682
Practice Address - Fax:518-346-9693
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2018-01-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY004847363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY070516000104OtherFIDELIS
NY970018724OtherMEDICARE RAILROAD
NY000498831001OtherBSNENY
NY356357OtherMVP HEALTHCARE
NY02216939Medicaid
NY000498831001OtherBSNENY
NYBB5666Medicare ID - Type Unspecified