Provider Demographics
NPI:1891412730
Name:CAMPBELL, KAYCE LEA (FNP)
Entity Type:Individual
Prefix:MS
First Name:KAYCE
Middle Name:LEA
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 1:426 NE SUMNER ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-3835
Mailing Address - Country:US
Mailing Address - Phone:979-220-5534
Mailing Address - Fax:
Practice Address - Street 1:1130 NW 22ND AVE STE 220
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2969
Practice Address - Country:US
Practice Address - Phone:503-413-8988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-21
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10000627363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
F09220695OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS