Provider Demographics
NPI:1184278756
Name:CAMPBELL, JESSI JADE (APRN)
Entity type:Individual
Prefix:
First Name:JESSI
Middle Name:JADE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1136
Mailing Address - Street 2:
Mailing Address - City:CAMPTON
Mailing Address - State:KY
Mailing Address - Zip Code:41301-1136
Mailing Address - Country:US
Mailing Address - Phone:606-668-7393
Mailing Address - Fax:866-718-4137
Practice Address - Street 1:592 KY 15 SOUTH SUITE 5
Practice Address - Street 2:
Practice Address - City:CAMPTON
Practice Address - State:KY
Practice Address - Zip Code:41301-4130
Practice Address - Country:US
Practice Address - Phone:606-205-3133
Practice Address - Fax:866-718-4137
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-31
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3013690363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty