Provider Demographics
NPI:1811243470
Name:CAMPBELL, ALICIA JEAN (PA-C)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:JEAN
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 MEAD AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-3531
Mailing Address - Country:US
Mailing Address - Phone:814-337-1144
Mailing Address - Fax:814-337-0941
Practice Address - Street 1:105 MEAD AVE
Practice Address - Street 2:SUITE C
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-3531
Practice Address - Country:US
Practice Address - Phone:814-337-1144
Practice Address - Fax:814-337-0941
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-31
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0004797363AM0700X
PAOA003455363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical