Provider Demographics
NPI:1720531056
Name:CAMPBELL, CARLA SUE (RN MSN CPNP)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:SUE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:RN MSN CPNP
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:SUE
Other - Last Name:DAVIDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7202 PINETEX DR
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77396-2660
Mailing Address - Country:US
Mailing Address - Phone:281-639-1882
Mailing Address - Fax:
Practice Address - Street 1:212 N BONHAM AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TX
Practice Address - Zip Code:77327-4023
Practice Address - Country:US
Practice Address - Phone:281-432-7400
Practice Address - Fax:281-432-7401
Is Sole Proprietor?:No
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP120068363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics