Provider Demographics
NPI:1134292964
Name:CAMPBELL, JENNIFER (PA-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 MONTGOMERY AVE # A
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37207-5215
Mailing Address - Country:US
Mailing Address - Phone:615-719-0718
Mailing Address - Fax:615-719-0718
Practice Address - Street 1:1404 MONTGOMERY AVE # A
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37207-5215
Practice Address - Country:US
Practice Address - Phone:615-719-0718
Practice Address - Fax:615-719-0718
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA172252363A00000X
TN924363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant