Provider Demographics
NPI:1053366252
Name:CAMPBELL, CAROL A (CRNP)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:A
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 WEST BROADDUS AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BOWLING GREEN
Mailing Address - State:VA
Mailing Address - Zip Code:22427-1596
Mailing Address - Country:US
Mailing Address - Phone:804-632-1030
Mailing Address - Fax:804-632-1033
Practice Address - Street 1:102 WEST BROADDUS AVE STE 200
Practice Address - Street 2:SUITE 200
Practice Address - City:BOWLING GREEN
Practice Address - State:VA
Practice Address - Zip Code:22427-2242
Practice Address - Country:US
Practice Address - Phone:804-632-1030
Practice Address - Fax:804-632-1033
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024167891363LF0000X
MDR110480363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDK220L367Medicare ID - Type Unspecified
MDQ45573Medicare UPIN
VAMC10853Medicare UPIN