Provider Demographics
NPI:1184176794
Name:CAMPBELL, JOLENE LEE (DNP, APRN, WHNP-BC)
Entity type:Individual
Prefix:DR
First Name:JOLENE
Middle Name:LEE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:DNP, APRN, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2960 S DONOVAN DR
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99623-8753
Mailing Address - Country:US
Mailing Address - Phone:907-921-9420
Mailing Address - Fax:907-921-9422
Practice Address - Street 1:2960 S DONOVAN DR
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99623-8753
Practice Address - Country:US
Practice Address - Phone:907-921-9420
Practice Address - Fax:907-921-9422
Is Sole Proprietor?:No
Enumeration Date:2016-10-30
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK114816363LP0808X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1686775Medicaid