Provider Demographics
NPI:1750329082
Name:CAMPBELL, KATHY (ARNP)
Entity type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 MASTER ST
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-1065
Mailing Address - Country:US
Mailing Address - Phone:859-277-9436
Mailing Address - Fax:859-977-0092
Practice Address - Street 1:1013 MASTER ST
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-1065
Practice Address - Country:US
Practice Address - Phone:606-280-7772
Practice Address - Fax:606-620-5416
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3628P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78006202Medicaid
KYP00305163OtherRAILROAD MEDICARE
KY000000522081OtherANTHEM BCBS
KYP34563Medicare UPIN
KY000000522081OtherANTHEM BCBS