Jackelynn Campos

Primary specialty

Child & Adolescent Psychiatric/Mental Health Registered NurseTaxonomy code 163WP0807X

License

95210993 Issued in CA

Practice address

3800 Coolidge Ave
Oakland, CA 94602-3399

Phone

(510) 482-2244

Fax

(510) 488-1960

NPI assigned

Feb 25, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1456358400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590969600000",
    "number": "1750741336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3800 COOLIDGE AVE",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946023399",
            "telephone_number": "510-482-2244",
            "fax_number": "510-488-1960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3800 COOLIDGE AVE",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946023399",
            "telephone_number": "510-482-2244",
            "fax_number": "510-488-1960"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3480 Buskirk Ave",
            "address_2": "210",
            "address_purpose": "LOCATION",
            "city": "Pleasant Hill",
            "state": "CA",
            "postal_code": "945234341",
            "country_code": "US",
            "telephone_number": "925-933-2627",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CAMPOS",
        "first_name": "JACKELYNN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-02-25",
        "last_updated": "2020-06-01",
        "certification_date": "2020-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163WP0807X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health, Child & Adolescent",
            "state": "CA",
            "license": "95210993",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shelitha Robertson Campbell, NP
• Valarie Campbell, M.A.
• William Campbell
• Dafne Cecilia Campos
• Emily Campos
• Meghan Campos
• Michael Anthony Campos
• Tatiana Campos
• Veronica Campos
• Dian Canaday

• Child & Adolescent Psychiatric/Mental Health Registered Nurse in Oakland, CA
• Providers in Oakland, CA by specialty
• Child & Adolescent Psychiatric/Mental Health Registered Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2020; 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.