Provider Demographics
NPI:1700224292
Name:CAMPBELL, NICCOLE READ (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:NICCOLE
Middle Name:READ
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 MIRROR LK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78260-4351
Mailing Address - Country:US
Mailing Address - Phone:210-488-1961
Mailing Address - Fax:
Practice Address - Street 1:18322 SONTERRA PL STE 107
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4196
Practice Address - Country:US
Practice Address - Phone:210-495-5771
Practice Address - Fax:210-966-9106
Is Sole Proprietor?:No
Enumeration Date:2013-06-06
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical