Provider Demographics
NPI:1144468851
Name:CAMPBELL, JESSICA GREGORY (CRNP)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:GREGORY
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LYNN
Other - Last Name:GREGORY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 N COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36037-2025
Mailing Address - Country:US
Mailing Address - Phone:334-382-2681
Mailing Address - Fax:
Practice Address - Street 1:300 N COLLEGE ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:AL
Practice Address - Zip Code:36037-2025
Practice Address - Country:US
Practice Address - Phone:334-382-2681
Practice Address - Fax:334-383-9541
Is Sole Proprietor?:No
Enumeration Date:2009-02-03
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-092091363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
1871003533OtherGROUP NPI