Kellie Lynn Campbell

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0110012371 Issued in VA

Practice address

1800 Novell PL
Provo, UT 84606-6171

Phone

(801) 375-5125

NPI assigned

May 9, 2025

Last updated

Sep 18, 2026By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Rocky Mountain University of Health Professions Foundation

  • Physical Therapist
  • Provo, UT
  • NPI 1053174417
  NPD

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

{
    "created_epoch": "1746748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1789689600000",
    "number": "1053101352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 NOVELL PL",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846066171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 NOVELL PL",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846066171",
            "telephone_number": "801-375-5125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAMPBELL",
        "first_name": "KELLIE",
        "middle_name": "LYNN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-05-09",
        "last_updated": "2026-09-18",
        "certification_date": "2026-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110012371",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Makayla Lynn Cammack
• William Kory Camp, LCSW
• Caleb Campbell
• Darren Campbell
• Ellen Shapiro Campbell, LCSW
• Michael Ryan Campbell
• Ned Nelson Campbell Jr., SSW
• Sarah Lauren Campbell, SOCIAL WORKER
• Tishna Lynn Campbell
• Ilse Karina Campista

• Physician Assistant in Provo, UT
• Providers in Provo, UT by specialty
• Physician Assistant in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.