Provider Demographics
NPI:1538524723
Name:CAMPBELL, KELLY (DO)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7101 S PADRE ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-4913
Mailing Address - Country:US
Mailing Address - Phone:361-761-3540
Mailing Address - Fax:361-761-3689
Practice Address - Street 1:6238 BOCA RATON CIR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-2636
Practice Address - Country:US
Practice Address - Phone:925-818-5591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-15
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX583150207R00000X
TXQ9792207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine