Provider Demographics
NPI:1841629904
Name:CAMPBELL, JAMIE LYN (MAS, ATC, LAT)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYN
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MAS, ATC, LAT
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:LYN
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11021 N OXFORD AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64157-5840
Mailing Address - Country:US
Mailing Address - Phone:816-352-8547
Mailing Address - Fax:
Practice Address - Street 1:2525 GLENN HENDREN DR
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-9600
Practice Address - Country:US
Practice Address - Phone:816-352-8547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-08
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20130016412255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer