Provider Demographics
NPI:1053755827
Name:CAMPBELL, KELLY ANNE (CRNP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ANNE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1370 WASHINGTON PIKE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:BRIDGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15017-2862
Mailing Address - Country:US
Mailing Address - Phone:412-221-0160
Mailing Address - Fax:412-221-0858
Practice Address - Street 1:1370 WASHINGTON PIKE
Practice Address - Street 2:SUITE 107
Practice Address - City:BRIDGEWILLE
Practice Address - State:PA
Practice Address - Zip Code:15017-2889
Practice Address - Country:US
Practice Address - Phone:412-221-0160
Practice Address - Fax:412-221-0858
Is Sole Proprietor?:No
Enumeration Date:2013-04-24
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASP012576363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics