Provider Demographics
NPI:1720183965
Name:CAMPBELL, SCOTT KERWIN (NP)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:KERWIN
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3029 COACH LITE DR
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-9151
Mailing Address - Country:US
Mailing Address - Phone:530-876-7995
Mailing Address - Fax:530-876-2159
Practice Address - Street 1:5734 CANYON VIEW DR
Practice Address - Street 2:
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-5503
Practice Address - Country:US
Practice Address - Phone:530-876-7995
Practice Address - Fax:530-876-2159
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP9315363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP9315OtherLICENSE
CANP9315OtherLICENSE
CAS03084Medicare UPIN