Individual provider Active NPI

John Kent Campbell, FNP

  • Nurse Practitioner
  • Tyler, TX
National Provider Identifier
1043252174
Registry record updated Aug 4, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
AP111386 Issued in TX
Practice address
1367 Dominion PLZ
Tyler, TX 75703-1013
Phone
(903) 534-6200
NPI assigned
Jun 12, 2006
Last updated
Aug 4, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X AP111386 TX Primary

Addresses

Primary practice location

1367 Dominion PLZ
Tyler, TX 75703-1013

Mailing address

1367 Dominion Plaza
Tyler, TX 75701
Phone (903) 534-6200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20061017000404 TX Practitioner - Nurse Practitioner 2668478553 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Oliver Street 5.01(a) IncGroup PAC ID 0042464125, 169 clinicians

Practice addresses (Care Compare)

1367 Dominion PLZ
Tyler, TX 75703-1013
Phone (903) 534-6200

317 Wilson St
Henderson
Henderson, TX 75652-5957
Phone (903) 658-8707

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as individual
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
AP111386TXMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Oliver Street 5.01(a) Inc. CurrentSince Dec 15, 2012 Accepting new patients
Dermatology Associates Past Accepting new patients
Smith Emergency Medicine Associates PA Nurse Practitioner Past Accepting new patients
Lawrence L Anderson MD PA Past Accepting new patients

Locations

1334 S Palestine St
Athens, TX 75751
Phone (903) 579-7205

317 Wilson St
Henderson, TX 75652
Phone (903) 405-3359

1367 Dominion Plz
Tyler, TX 75703
Phone (903) 534-6200

1720 S Beckham Ave
Ste 102
Tyler, TX 75701
Phone (903) 534-6200

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1501804800000",
    "number": "1043252174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1367 DOMINION PLAZA",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "75701",
            "telephone_number": "903-534-6200",
            "fax_number": "903-939-0755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1367 DOMINION PLZ",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757031013",
            "telephone_number": "903-534-6200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAMPBELL",
        "first_name": "JOHN",
        "middle_name": "KENT",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-12",
        "last_updated": "2017-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "AP111386",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.