Provider Demographics
NPI:1558242644
Name:CAMPBELL, KELSI SHANNON (APRN)
Entity type:Individual
Prefix:
First Name:KELSI
Middle Name:SHANNON
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KELSI
Other - Middle Name:SHANNON
Other - Last Name:ELDRIDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2038 BIG BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:VIPER
Mailing Address - State:KY
Mailing Address - Zip Code:41774-8526
Mailing Address - Country:US
Mailing Address - Phone:606-233-2527
Mailing Address - Fax:
Practice Address - Street 1:200 MEDICAL CENTER DR STE 3P
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-9478
Practice Address - Country:US
Practice Address - Phone:606-487-7955
Practice Address - Fax:606-487-7949
Is Sole Proprietor?:No
Enumeration Date:2025-09-08
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4038648363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care