Individual
KEVIN CAMPBELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-BC
Contact information
Practice address
304 MOUNT MERCY DR, PEWEE VALLEY, KY 40056-8020
(502) 241-8611
(502) 241-4175
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
3009043
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50083157
PASSPORT
KY
05
—
7100326440
—
KY
Enumeration date
12/29/2014
Last updated
07/26/2016
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