Provider Demographics
NPI:1801174404
Name:CAMPBELL, KATHRYN BAUK (RN, CPNP)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:BAUK
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:RN, CPNP
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:MARIE
Other - Last Name:BAUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, CPNP
Mailing Address - Street 1:2 WHEELER ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-5700
Mailing Address - Country:US
Mailing Address - Phone:912-353-7744
Mailing Address - Fax:617-730-0621
Practice Address - Street 1:2 WHEELER ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-5700
Practice Address - Country:US
Practice Address - Phone:912-353-7744
Practice Address - Fax:617-730-0621
Is Sole Proprietor?:No
Enumeration Date:2011-07-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20111450363LP0200X
MARN2307499363LP0200X
GARN272845363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
1801174404OtherNPI
1801174404OtherNPI