Provider Demographics
NPI:1700960952
Name:CAMPBELL, CHERYL LYNN (RN FNP)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:LYNN
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:RN FNP
Other - Prefix:MISS
Other - First Name:CHERYL
Other - Middle Name:LYNN
Other - Last Name:STASTNY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN FNP
Mailing Address - Street 1:2701 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901
Mailing Address - Country:US
Mailing Address - Phone:361-573-9181
Mailing Address - Fax:361-582-5752
Practice Address - Street 1:2701 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901
Practice Address - Country:US
Practice Address - Phone:361-573-9181
Practice Address - Fax:361-582-5752
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX667427363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8D9370Medicare ID - Type Unspecified
TXQ51482Medicare UPIN