Provider Demographics
NPI:1144294646
Name:CAMPBELL, GERALDINE G (APRN-BC)
Entity type:Individual
Prefix:MRS
First Name:GERALDINE
Middle Name:G
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301-2001
Mailing Address - Country:US
Mailing Address - Phone:870-735-3842
Mailing Address - Fax:870-394-4817
Practice Address - Street 1:1008 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MARVELL
Practice Address - State:AR
Practice Address - Zip Code:72366-9486
Practice Address - Country:US
Practice Address - Phone:870-829-1194
Practice Address - Fax:870-407-5037
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01469363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily