Provider Demographics
NPI:1194520775
Name:CAMPBELL, PATTY ANNE (RD)
Entity type:Individual
Prefix:MRS
First Name:PATTY
Middle Name:ANNE
Last Name:CAMPBELL
Suffix:
Gender:
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2657 WINDMILL PKWY # 186
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-3384
Mailing Address - Country:US
Mailing Address - Phone:702-335-4211
Mailing Address - Fax:
Practice Address - Street 1:2448 BLACKCRAIG ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89044-8758
Practice Address - Country:US
Practice Address - Phone:702-335-4211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV32027-DI-6133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal