Provider Demographics
NPI:1659993152
Name:CAMPBELL, RENEE (APRN, CNM, WHNP-BC)
Entity Type:Individual
Prefix:DR
First Name:RENEE
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:APRN, CNM, WHNP-BC
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:
Other - Last Name:NELLIS/DEJAYNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:7980 NEW LA GRANGE RD STE 7
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-4767
Mailing Address - Country:US
Mailing Address - Phone:502-383-3912
Mailing Address - Fax:
Practice Address - Street 1:7980 NEW LA GRANGE RD STE 7
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4767
Practice Address - Country:US
Practice Address - Phone:502-383-3912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-07
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN09000287A367A00000X
CNM04005367A00000X
KY3011101367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife