Provider Demographics
NPI:1740600519
Name:CAMPBELL, NAKIA M (LPN,LMT)
Entity Type:Individual
Prefix:MS
First Name:NAKIA
Middle Name:M
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LPN,LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 N JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-3525
Mailing Address - Country:US
Mailing Address - Phone:931-841-4491
Mailing Address - Fax:
Practice Address - Street 1:201 WESLEY ST
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-5158
Practice Address - Country:US
Practice Address - Phone:931-841-4491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN66267164W00000X
TN10218225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No164W00000XNursing Service ProvidersLicensed Practical Nurse