Provider Demographics
NPI:1972281715
Name:CAMPBELL, JERRY LEE JR (APRN)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:LEE
Last Name:CAMPBELL
Suffix:JR
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1550 HIGHWAY 15 S STE 240
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:KY
Mailing Address - Zip Code:41339-0709
Mailing Address - Country:US
Mailing Address - Phone:606-272-7533
Mailing Address - Fax:606-824-5042
Practice Address - Street 1:1550 HIGHWAY 15 S STE 240
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:KY
Practice Address - Zip Code:41339-0709
Practice Address - Country:US
Practice Address - Phone:606-272-7533
Practice Address - Fax:606-824-5042
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4007079363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care