Provider Demographics
NPI:1750646725
Name:CAMPBELL, TRISHA KELLY (APRN)
Entity Type:Individual
Prefix:
First Name:TRISHA
Middle Name:KELLY
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 SUGAR MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:KY
Mailing Address - Zip Code:42206-5352
Mailing Address - Country:US
Mailing Address - Phone:270-542-5500
Mailing Address - Fax:270-542-5502
Practice Address - Street 1:128 SUGAR MAPLE DR
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:KY
Practice Address - Zip Code:42206-5352
Practice Address - Country:US
Practice Address - Phone:270-542-5500
Practice Address - Fax:270-542-5502
Is Sole Proprietor?:No
Enumeration Date:2012-07-05
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY3007525363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily