Provider Demographics
NPI:1265285415
Name:CAMPBELL, KERI LYNN
Entity type:Individual
Prefix:
First Name:KERI
Middle Name:LYNN
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51870 E POINTE LN
Mailing Address - Street 2:
Mailing Address - City:NEW BALTIMORE
Mailing Address - State:MI
Mailing Address - Zip Code:48051-2350
Mailing Address - Country:US
Mailing Address - Phone:586-265-9591
Mailing Address - Fax:
Practice Address - Street 1:30229 N PARK DR APT 307
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48047-3511
Practice Address - Country:US
Practice Address - Phone:586-265-9591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health