Provider Demographics
NPI:1811239874
Name:CAMPBELL, KATREVIA SHYTERIA (CNM)
Entity Type:Individual
Prefix:MS
First Name:KATREVIA
Middle Name:SHYTERIA
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 NW 201ST ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33169-2930
Mailing Address - Country:US
Mailing Address - Phone:305-409-7476
Mailing Address - Fax:
Practice Address - Street 1:16601 NE 19TH AVE
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-3149
Practice Address - Country:US
Practice Address - Phone:305-944-2902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-18
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9270010367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife