Tyler Michael Campbell
Individual provider Active NPI Athletic Trainer · Pittsburg, KS
NPI 1942937826 · NPPES record last updated Aug 2, 2022
Key facts
- NPI
- 1942937826
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- License
- 24-01618 (KS)
- Practice address
- 1701 S Broadway St
Pittsburg, KS 66762-7500 - Phone
- (417) 262-3637
- NPI assigned
- Aug 2, 2022
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 24-01618 | KS | MD | Athletic Trainer |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Psu Student Health Center | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 24-01618 | KS | Yes |
Addresses
Primary practice location
1701 S Broadway St
Pittsburg, KS 66762-7500
Mailing address
206 W 2ND St
Lamar, MO 64759-1031
Phone (417) 262-3637
Other providers in Pittsburg, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 2, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.