Individual provider Active NPI

Kim Campbell, PAC

  • Medical Physician Assistant
  • Tulsa, OK
National Provider Identifier
1164443610
Registry record updated Jun 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
197 Issued in OK
Practice address
1145 S Utica Ave Ste 460
Tulsa, OK 74104-4041
Phone
(918) 579-5749
Fax
(918) 579-5762
NPI assigned
Jul 21, 2006
Last updated
Jun 21, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 197 OK Primary

Addresses

Primary practice location

1145 S Utica Ave Ste 460
Tulsa, OK 74104-4041

Mailing address

1145 S Utica Ave
Ste 460
Tulsa, OK 74104-4041
Phone (918) 579-5749

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)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
197OKMDOrthodontics and Dentofacial Orthopedic Dentist

Practice roles

OrganizationSpecialtyStatusNew patients
Morad El-Raheb MD Inc PC CurrentSince Oct 15, 2005 Accepting new patients

Locations

1145 S Utica Ave
Ste 1105
Tulsa, OK 74104
Phone (918) 579-5724

1145 S Utica Ave
Ste 460
Tulsa, OK 74104
Phone (918) 392-8884

Organizations & group practices 1

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": "1153440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561075200000",
    "number": "1164443610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1145 S UTICA AVE",
            "address_2": "STE 460",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741044041",
            "telephone_number": "918-579-5749",
            "fax_number": "918-579-5762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1145 S UTICA AVE STE 460",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741044041",
            "telephone_number": "918-579-5749",
            "fax_number": "918-579-5762"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAMPBELL",
        "first_name": "KIM",
        "name_prefix": "Mr.",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-21",
        "last_updated": "2019-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OK",
            "license": "197",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2019; 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.