Provider Demographics
NPI:1689920209
Name:CAMPBELL, PATRICIA L (CFNP)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:L
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 ELKIN CT
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:MS
Mailing Address - Zip Code:39341-2311
Mailing Address - Country:US
Mailing Address - Phone:662-726-9769
Mailing Address - Fax:
Practice Address - Street 1:606 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:MS
Practice Address - Zip Code:39341-2242
Practice Address - Country:US
Practice Address - Phone:662-726-4264
Practice Address - Fax:662-726-4204
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-01
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR856111363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily