Provider Demographics
NPI:1972531259
Name:CAMPBELL, TERRY S (MSN, CNM, ARNP)
Entity Type:Individual
Prefix:MS
First Name:TERRY
Middle Name:S
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MSN, CNM, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40212-1033
Mailing Address - Country:US
Mailing Address - Phone:502-774-8631
Mailing Address - Fax:502-778-3499
Practice Address - Street 1:2215 PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40212-1033
Practice Address - Country:US
Practice Address - Phone:502-774-8631
Practice Address - Fax:502-778-3499
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY812P363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78000213Medicaid
KYK040975Medicare PIN
KYK040976Medicare PIN
KY78000213Medicaid
KY0979714Medicare PIN
KYK040974Medicare PIN
KY0722542Medicare PIN
KYK040977Medicare PIN
KYK040973Medicare PIN
KYK040972Medicare PIN