Provider Demographics
NPI:1992356554
Name:CAMPBELL, COURTNEY MEREDITH (FNP-C)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:MEREDITH
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 HESTER AVE APT 103
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-3651
Mailing Address - Country:US
Mailing Address - Phone:469-964-3404
Mailing Address - Fax:
Practice Address - Street 1:12300 INWOOD RD STE 106
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-8032
Practice Address - Country:US
Practice Address - Phone:214-444-3265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP142825363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily