Provider Demographics
NPI:1881035889
Name:CAMPO, RAY LEWIS JR (FNP)
Entity Type:Individual
Prefix:MR
First Name:RAY
Middle Name:LEWIS
Last Name:CAMPO
Suffix:JR
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61159 W. SPRINGMILL DRIVE
Mailing Address - Street 2:
Mailing Address - City:LACOMBE
Mailing Address - State:LA
Mailing Address - Zip Code:70445
Mailing Address - Country:US
Mailing Address - Phone:985-882-6739
Mailing Address - Fax:985-882-6739
Practice Address - Street 1:61159 W SPRINGMILL DR
Practice Address - Street 2:
Practice Address - City:LACOMBE
Practice Address - State:LA
Practice Address - Zip Code:70445-3033
Practice Address - Country:US
Practice Address - Phone:985-882-6739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-08
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07349363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2339630Medicaid
LA2997997Medicare PIN