Provider Demographics
NPI:1659416857
Name:CAMPBELL, KRISTY A
Entity Type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:A
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:A
Other - Last Name:COSTANZO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 195002
Mailing Address - Street 2:
Mailing Address - City:KODIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99619-5002
Mailing Address - Country:US
Mailing Address - Phone:907-487-5757
Mailing Address - Fax:907-487-5151
Practice Address - Street 1:CAPE SARICHEF RD BLDG N46
Practice Address - Street 2:HSWL FO KODIAK
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99619
Practice Address - Country:US
Practice Address - Phone:907-487-5757
Practice Address - Fax:907-487-5151
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other