Provider Demographics
NPI:1720050354
Name:CAMPBELL, KATHARINE K (PA)
Entity type:Individual
Prefix:MS
First Name:KATHARINE
Middle Name:K
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:430 FISHER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-7700
Mailing Address - Country:US
Mailing Address - Phone:828-586-4012
Mailing Address - Fax:828-586-5162
Practice Address - Street 1:430 FISHER CREEK RD
Practice Address - Street 2:
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-7700
Practice Address - Country:US
Practice Address - Phone:828-586-4012
Practice Address - Fax:828-586-5162
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC100713363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP34563Medicare UPIN