Provider Demographics
NPI:1952536211
Name:CAMPBELL, CURTIS GLENN (MMSC PA-C)
Entity type:Individual
Prefix:
First Name:CURTIS
Middle Name:GLENN
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:MMSC PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 SPAULDING AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-4715
Mailing Address - Country:US
Mailing Address - Phone:509-578-1016
Mailing Address - Fax:509-472-3729
Practice Address - Street 1:1445 SPAULDING AVE STE 102
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4715
Practice Address - Country:US
Practice Address - Phone:509-578-1016
Practice Address - Fax:509-472-3729
Is Sole Proprietor?:No
Enumeration Date:2009-05-15
Last Update Date:2023-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA 60178683363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPA60178683OtherWA ALLOPATHIC BOARD
LA5CRPB63OtherMEDICARE PTAN
LA1810142Medicaid