Provider Demographics
NPI:1659589067
Name:CAMPBELL, KIMBERLY A
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:A
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 PINE TOP LN
Mailing Address - Street 2:
Mailing Address - City:KRYPTON
Mailing Address - State:KY
Mailing Address - Zip Code:41754-9059
Mailing Address - Country:US
Mailing Address - Phone:606-436-6793
Mailing Address - Fax:606-436-6793
Practice Address - Street 1:21 PINE TOP LN
Practice Address - Street 2:
Practice Address - City:KRYPTON
Practice Address - State:KY
Practice Address - Zip Code:41754-9059
Practice Address - Country:US
Practice Address - Phone:606-436-6793
Practice Address - Fax:606-436-6793
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY01958OtherFIRST STEPS