Kelly A Campbell

Primary specialty

Independent Duty CorpsmanTaxonomy code 1710I1002X

Practice address

34101 Farenholt Ave
BLDG 14 RM 230
San Diego, CA 92134-5291

Phone

(619) 532-5104

NPI assigned

Mar 8, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Kelly A Wade Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1141776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1290988800000",
    "number": "1336117258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34101 FARENHOLT AVE",
            "address_2": "BLDG 14 RM 230",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921345291",
            "telephone_number": "619-532-5104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34101 FARENHOLT AVE",
            "address_2": "BLDG 14 RM 230",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921345291",
            "telephone_number": "619-532-5104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAMPBELL",
        "first_name": "KELLY",
        "middle_name": "A",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-03-08",
        "last_updated": "2010-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1710I1002X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider, Independent Duty Corpsman",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "WADE",
            "middle_name": "A",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jennifer Helen Campbell, M.D.
• Joanne Campbell, RPA-C
• Kali Campbell
• Katari Amina Campbell, LCSW
• Katelyn Campbell
• Kristen Knightly Campbell, DPT
• Laura Michelle Campbell, PHD
• Laurie Ann Campbell, LCSW
• Lavonderick Lavar Campbell Sr.
• Leonie Campbell, MD

• Independent Duty Corpsman in San Diego, CA
• Providers in San Diego, CA by specialty
• Independent Duty Corpsman in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2010; 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.