Provider Demographics
NPI:1821664350
Name:CAMPBELL, DEONNA (APRN-PMHNP)
Entity Type:Individual
Prefix:
First Name:DEONNA
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:APRN-PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1988
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41702-1988
Mailing Address - Country:US
Mailing Address - Phone:606-476-2274
Mailing Address - Fax:606-476-2304
Practice Address - Street 1:10616 S. KY HWY 15
Practice Address - Street 2:
Practice Address - City:SCUDDY
Practice Address - State:KY
Practice Address - Zip Code:41760-9033
Practice Address - Country:US
Practice Address - Phone:606-476-2274
Practice Address - Fax:606-476-2304
Is Sole Proprietor?:No
Enumeration Date:2021-06-03
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3016159363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health