Basic Information
| Provider Information | |||||||||
| NPI: | 1215549936 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAMPBELL | ||||||||
| FirstName: | MARIE | ||||||||
| MiddleName: | HOPE | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 240 CAPITOL ST STE 500 | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253012297 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043441623 | ||||||||
| FaxNumber: | 3043445853 | ||||||||
| Practice Location | |||||||||
| Address1: | 1275 SOUTHVIEW DR | ||||||||
| Address2: | |||||||||
| City: | BLUEFIELD | ||||||||
| State: | WV | ||||||||
| PostalCode: | 247014347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046755236 | ||||||||
| FaxNumber: | 3043277660 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2020 | ||||||||
| LastUpdateDate: | 11/09/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 0024179932 | VA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363L00000X | 111018 | WV | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.