Provider Demographics
NPI:1023874658
Name:CAMPBELL, ROBERT ALEXANDER JR (FNP-BC)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ALEXANDER
Last Name:CAMPBELL
Suffix:JR
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:749 DEEP SOUTH CT
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29550-8095
Mailing Address - Country:US
Mailing Address - Phone:603-986-6225
Mailing Address - Fax:
Practice Address - Street 1:701 MEDICAL PARK DR STE 207
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-4778
Practice Address - Country:US
Practice Address - Phone:843-383-5191
Practice Address - Fax:843-332-9229
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-21
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC28422363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty