Provider Demographics
NPI:1710412614
Name:CAMPBELL, JOY (APRN)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 101
Mailing Address - Street 2:
Mailing Address - City:GARFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:40140-0101
Mailing Address - Country:US
Mailing Address - Phone:270-668-3373
Mailing Address - Fax:
Practice Address - Street 1:151 DREXLER CIR STE 1
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-7843
Practice Address - Country:US
Practice Address - Phone:270-506-2730
Practice Address - Fax:270-900-0704
Is Sole Proprietor?:No
Enumeration Date:2017-04-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1093016163WP0808X
KY3011434363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health