Provider Demographics
NPI:1861730509
Name:CAMPBELL, CORNELIA CAROLINA (APRN)
Entity type:Individual
Prefix:MRS
First Name:CORNELIA
Middle Name:CAROLINA
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6725 SW 29TH ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-5625
Mailing Address - Country:US
Mailing Address - Phone:785-354-0517
Mailing Address - Fax:
Practice Address - Street 1:6725 SW 29TH ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-5625
Practice Address - Country:US
Practice Address - Phone:785-354-0517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-30
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-75878-082363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201072670BMedicaid
KS30004069880001Medicaid