Individual
MADELENA CAMPBELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, CPNP-BC, CPN
Contact information
Practice address
12261 HIGHWAY 49, SUITE 11, GULFPORT, MS 39503-2975
(228) 867-5185
(228) 867-5189
Mailing address
PO BOX 1810, GULFPORT, MS 39502-1810
(228) 896-6441
(228) 896-6576
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R868611
MS
363LP0200X
Pediatric Nurse Practitioner
Primary
868611
MS
363LP0200X
Pediatric Nurse Practitioner
R868611
MS
Other
Enumeration date
08/20/2011
Last updated
04/28/2020
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