Provider Demographics
NPI:1336563675
Name:CAMPBELL, COURTNEY (ACNP)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5115 FANNIN ST STE 801
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-5870
Mailing Address - Country:US
Mailing Address - Phone:713-790-0841
Mailing Address - Fax:713-790-1350
Practice Address - Street 1:1721 BIRMINGHAM RD
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-4082
Practice Address - Country:US
Practice Address - Phone:979-764-1474
Practice Address - Fax:979-764-9249
Is Sole Proprietor?:No
Enumeration Date:2014-02-06
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX697302363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1336563675Medicaid
TX8787NPOtherBLUE CROSS BLUE SHIELD OF TEXAS