Provider Demographics
NPI:1457548323
Name:CAMPBELL, SHERRELL FAITH (PMHNP, PMHCS, BC)
Entity type:Individual
Prefix:
First Name:SHERRELL
Middle Name:FAITH
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:PMHNP, PMHCS, BC
Other - Prefix:
Other - First Name:SHERRY
Other - Middle Name:FAITH
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PMHNP, PMHCS, BC
Mailing Address - Street 1:4024 STIRRUP CREEK DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-9464
Mailing Address - Country:US
Mailing Address - Phone:301-712-8084
Mailing Address - Fax:240-362-7110
Practice Address - Street 1:4024 STIRRUP CREEK DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-9464
Practice Address - Country:US
Practice Address - Phone:919-908-9787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR067998163WP0809X, 363LP0808X
MDAC003856363LP0808X
NC5011305363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5562490Medicaid
MD953L513EMedicare PIN
MD953LMedicare PIN