Provider Demographics
NPI:1891363081
Name:CAMPBELL, CAMRY DANIELLE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:CAMRY
Middle Name:DANIELLE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 S COLORADO ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38703-7219
Mailing Address - Country:US
Mailing Address - Phone:662-332-9872
Mailing Address - Fax:662-332-9878
Practice Address - Street 1:1502 S COLORADO ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38703-7219
Practice Address - Country:US
Practice Address - Phone:662-332-9872
Practice Address - Fax:662-332-9878
Is Sole Proprietor?:No
Enumeration Date:2021-06-14
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904696363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner