Provider Demographics
NPI:1801816780
Name:CAMPBELL, JAN L (MD)
Entity Type:Individual
Prefix:DR
First Name:JAN
Middle Name:L
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF KANSAS MEDICAL CTR
Mailing Address - Street 2:3901 RAINBOW BLVD, MS 4015
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160-0001
Mailing Address - Country:US
Mailing Address - Phone:913-588-6493
Mailing Address - Fax:913-588-6414
Practice Address - Street 1:UNIVERSITY OF KANSAS MEDICAL CTR
Practice Address - Street 2:3901 RAINBOW BLVD, MS 4015
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-0001
Practice Address - Country:US
Practice Address - Phone:913-588-6493
Practice Address - Fax:913-588-6414
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS04-267662084P0800X
IA215282084P0800X
MOR5H102084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100424720AMedicaid
MO205918303Medicaid
MO205918303Medicaid
C51808Medicare UPIN