Provider Demographics
NPI:1770876377
Name:CAMPBELL, AMY CALVERT (CFNP)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:CALVERT
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:CFNP
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Other - Credentials:
Mailing Address - Street 1:PO BOX 649113
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75264-9113
Mailing Address - Country:US
Mailing Address - Phone:855-343-5763
Mailing Address - Fax:855-343-5763
Practice Address - Street 1:2080 S FRONTAGE RD STE 112
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39180-5882
Practice Address - Country:US
Practice Address - Phone:601-883-6304
Practice Address - Fax:601-883-6325
Is Sole Proprietor?:No
Enumeration Date:2011-05-16
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MSR881049163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSR881049OtherLICENSE