Provider Demographics
NPI:1396943023
Name:CAMPBELL, CONNIE (LMT)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 842
Mailing Address - Street 2:207 NORTH MAIN AVE
Mailing Address - City:LAMESA
Mailing Address - State:TX
Mailing Address - Zip Code:79331-0842
Mailing Address - Country:US
Mailing Address - Phone:806-872-3958
Mailing Address - Fax:
Practice Address - Street 1:207 N MAIN AVE
Practice Address - Street 2:
Practice Address - City:LAMESA
Practice Address - State:TX
Practice Address - Zip Code:79331-5533
Practice Address - Country:US
Practice Address - Phone:806-872-3958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT015603171W00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171W00000XOther Service ProvidersContractor
Not Answered174400000XOther Service ProvidersSpecialist