Individual
HEIDI DIANE CAMPBELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
865 W LAKE DR, MOUNT AIRY, NC 27030-2102
(336) 719-6100
(336) 719-2313
Mailing address
PO BOX 751803, CHARLOTTE, NC 28275-1803
(336) 719-6100
(336) 719-2313
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
104022
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00457713
RAILROAD MEDICARE
NC
Enumeration date
10/17/2006
Last updated
03/07/2023
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