Provider Demographics
NPI:1386726131
Name:CAMPBELL, KRISTINA T (NP)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:T
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5415 RAPIDAN CT
Mailing Address - Street 2:
Mailing Address - City:LOTHIAN
Mailing Address - State:MD
Mailing Address - Zip Code:20711-9673
Mailing Address - Country:US
Mailing Address - Phone:704-408-2842
Mailing Address - Fax:
Practice Address - Street 1:5415 RAPIDAN CT
Practice Address - Street 2:
Practice Address - City:LOTHIAN
Practice Address - State:MD
Practice Address - Zip Code:20711-9673
Practice Address - Country:US
Practice Address - Phone:704-408-2842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR190635363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q73633Medicare UPIN
2592733Medicare PIN