Provider Demographics
NPI:1053352518
Name:CAMPBELL, ELIZABETH SHAWN (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:SHAWN
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3213 SUMMIT SQUARE PL
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2636
Mailing Address - Country:US
Mailing Address - Phone:859-381-1066
Mailing Address - Fax:859-263-0650
Practice Address - Street 1:211 FOUNTAIN CT STE 230
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2696
Practice Address - Country:US
Practice Address - Phone:859-629-7200
Practice Address - Fax:859-629-7212
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY28431207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000290316OtherANTHEM
KY64284318Medicaid
KYE75200Medicare UPIN
KY64284318Medicaid
KY0783101Medicare ID - Type Unspecified