Provider Demographics
NPI:1902958515
Name:CAMPBELL, AMY L (RD, LD, CDE)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:RD, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3831 BELLEAU WOOD DR APT 15
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-1877
Mailing Address - Country:US
Mailing Address - Phone:859-312-1797
Mailing Address - Fax:
Practice Address - Street 1:650 NEWTOWN PIKE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-1113
Practice Address - Country:US
Practice Address - Phone:859-252-2371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-1663133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0037685Medicare ID - Type Unspecified