Ted Campbell

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

Practice address

1300 Moore St
Fairbanks, AK 99701-5761

Phone

(907) 452-8251

NPI assigned

May 4, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

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": "1178236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725494400000",
    "number": "1609088491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1717 W COWLES ST",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997015926",
            "telephone_number": "907-452-8251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 MOORE ST",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997015761",
            "telephone_number": "907-452-8251"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1408 19th Avenue",
            "address_purpose": "LOCATION",
            "city": "Fairbanks",
            "state": "AK",
            "postal_code": "99701",
            "country_code": "US",
            "telephone_number": "907-459-3800",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3101 Lathrop St",
            "address_purpose": "LOCATION",
            "city": "Fairbanks",
            "state": "AK",
            "postal_code": "997017426",
            "country_code": "US",
            "telephone_number": "907-459-4799",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CAMPBELL",
        "first_name": "TED",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-04",
        "last_updated": "2024-09-05",
        "certification_date": "2024-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Colin Emile Stafford Campbell, DPT
• Leslie A Campbell, MT
• Michael Campbell
• Raymond Campbell
• Sierra N Campbell
• Charlotte Anne Cannon, CCC SLP
• James E Cannon
• Melanie Susan Cannon, ARNP
• Scott Lawrence Cannon, M.D.
• Tammy Cannon

• Community Health Worker in Fairbanks, AK
• Providers in Fairbanks, AK by specialty
• Community Health Worker in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2024; 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.