Provider Demographics
NPI:1922579994
Name:DEO CAMPO, RACHEL CATHLEEN (FNP)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:CATHLEEN
Last Name:DEO CAMPO
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 1:147 REYNOIR ST STE 101
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39530-4119
Mailing Address - Country:US
Mailing Address - Phone:228-374-2051
Mailing Address - Fax:
Practice Address - Street 1:147 REYNOIR ST STE 101
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39530-4119
Practice Address - Country:US
Practice Address - Phone:228-374-2051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903084363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily