Provider Demographics
NPI:1023834074
Name:CAMPBELL, JAMIE LEE
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:LEE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 OLD CLINE RD
Mailing Address - Street 2:
Mailing Address - City:GHENT
Mailing Address - State:WV
Mailing Address - Zip Code:25843-9349
Mailing Address - Country:US
Mailing Address - Phone:304-890-1143
Mailing Address - Fax:
Practice Address - Street 1:205 OLD CLINE RD
Practice Address - Street 2:
Practice Address - City:GHENT
Practice Address - State:WV
Practice Address - Zip Code:25843-9349
Practice Address - Country:US
Practice Address - Phone:304-890-1143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-25
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist