Provider Demographics
NPI:1841246501
Name:CAMPBELL, THERESA J (FNP)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:J
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:557 SANDHURST DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-4433
Mailing Address - Country:US
Mailing Address - Phone:910-484-8114
Mailing Address - Fax:910-484-1564
Practice Address - Street 1:557 SANDHURST DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4433
Practice Address - Country:US
Practice Address - Phone:910-484-8114
Practice Address - Fax:910-484-1564
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201393363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7000226Medicaid
NCP17101Medicare UPIN
NC2599387Medicare ID - Type UnspecifiedMEDICARE #