Richard Lee Campbell, RN

Key facts

NPI

1700344702

Entity type

Individual (NPI type 1)

Primary specialty

Registered Nurse 163W00000X

License

RN194044 (AZ)

Practice address

Hwy 160 MP 394.3
Kayenta, AZ 86033-0368

Phone

(928) 697-4100

Fax

(928) 697-4029

NPI assigned

Mar 8, 2019

Sex

Male

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Credentials

Registered Nurse

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 8, 2019.

{
    "created_epoch": "1552003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1552003200000",
    "number": "1700344702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3433 ORO GRANDE BLVD UNIT 101",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864067273",
            "telephone_number": "928-230-9835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "HWY 160 MP 394.3",
            "city": "KAYENTA",
            "state": "AZ",
            "postal_code": "860330368",
            "telephone_number": "928-697-4100",
            "fax_number": "928-697-4029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAMPBELL",
        "first_name": "RICHARD",
        "middle_name": "LEE",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-08",
        "last_updated": "2019-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "AZ",
            "license": "RN194044",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OR",
            "license": "201707038RN",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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