Provider Demographics
NPI:1124120035
Name:CAMPBELL, LENORA KAY (APRN)
Entity type:Individual
Prefix:
First Name:LENORA
Middle Name:KAY
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 WINDY HILL RD SE
Mailing Address - Street 2:STE 215
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8654
Mailing Address - Country:US
Mailing Address - Phone:770-850-8464
Mailing Address - Fax:
Practice Address - Street 1:21154 HIGHWAY 421 # 1
Practice Address - Street 2:
Practice Address - City:HYDEN
Practice Address - State:KY
Practice Address - Zip Code:41749-8553
Practice Address - Country:US
Practice Address - Phone:606-672-1208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2560P363L00000X
KY3002560363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78006939Medicaid
00051005Medicare PIN
KY78006939Medicaid
0776314Medicare PIN
KYP05633Medicare UPIN
183947Medicare Oscar/Certification