Active NPI
Theadora Devone Campbell, PA-C
- Physician Assistant
- Fayetteville, NC
National Provider Identifier
1689635377
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 102996
- Practice address
- 2300 Ramsey St
Fayetteville, NC 28301-3856 - Phone
- (910) 488-2120
- NPI assigned
- Mar 31, 2006
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 102996 | NC | Primary |
Addresses
Primary practice location
2300 Ramsey St
Fayetteville, NC 28301-3856
Mailing address
6556 Foxberry Rd
Fayetteville, NC 28314-1874
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110406000769 | NC | Order and Referring Only - Physician Assistant | 1052595618 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143763200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1689635377",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6556 FOXBERRY RD",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "283141874"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2300 RAMSEY ST",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "283013856",
"telephone_number": "910-488-2120"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CAMPBELL",
"first_name": "THEADORA",
"middle_name": "DEVONE",
"name_prefix": "Ms.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-31",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NC",
"license": "102996",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.