Provider Demographics
NPI:1437190790
Name:CAMPBELL, JESSICA BEATRICE
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:BEATRICE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1246 ASHLAND AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-2861
Mailing Address - Country:US
Mailing Address - Phone:740-453-0730
Mailing Address - Fax:
Practice Address - Street 1:1246 ASHLAND AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-2861
Practice Address - Country:US
Practice Address - Phone:740-453-0730
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0577732086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0721802Medicaid
OH0721802Medicaid
OHB61979Medicare UPIN