Provider Demographics
NPI:1881605442
Name:CAMPBELL, DONNA L (APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:L
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40203-2202
Mailing Address - Country:US
Mailing Address - Phone:502-585-9444
Mailing Address - Fax:502-585-9466
Practice Address - Street 1:215 RAINBOW WAY
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-5374
Practice Address - Country:US
Practice Address - Phone:812-284-1760
Practice Address - Fax:812-288-6853
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3004453363LF0000X, 363LP0808X
IN71006794A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78015302Medicaid
KYQ55998Medicare UPIN
KY78015302Medicaid
KY78015302Medicaid