Active NPI
Mary Kattherine Campbell, RN
- Durable Medical Equipment & Medical Supplies
- Beckley, WV
National Provider Identifier
1104909563
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Durable Medical Equipment & Medical Supplies
- License
- 011870
- Practice address
- 103 Herbert Dr
Beckley, WV 25801-2186 - Phone
- (304) 890-0263
- Fax
- (304) 253-9569
- NPI assigned
- Oct 21, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | 011870 | WV | Primary |
Addresses
Primary practice location
103 Herbert Dr
Beckley, WV 25801-2186
Mailing address
103 Herbert Dr
Beckley, WV 25801-2186
Phone (304) 890-0263
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 011870 | WV | MD | Durable Medical Equipment & Medical Supplies |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161388800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1104909563",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "103 HERBERT DR",
"city": "BECKLEY",
"state": "WV",
"postal_code": "258012186",
"telephone_number": "304-890-0263",
"fax_number": "304-253-9569"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "103 HERBERT DR",
"city": "BECKLEY",
"state": "WV",
"postal_code": "258012186",
"telephone_number": "304-890-0263",
"fax_number": "304-253-9569"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CAMPBELL",
"first_name": "MARY",
"middle_name": "KATTHERINE",
"name_prefix": "Mrs.",
"credential": "RN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": "WV",
"license": "011870",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Beckley, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.