Basic Information
| Provider Information | |||||||||
| NPI: | 1720183965 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAMPBELL | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | KERWIN | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3029 COACH LITE DR | ||||||||
| Address2: | |||||||||
| City: | CHICO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959739151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308767995 | ||||||||
| FaxNumber: | 5308762159 | ||||||||
| Practice Location | |||||||||
| Address1: | 5734 CANYON VIEW DR | ||||||||
| Address2: | |||||||||
| City: | PARADISE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959695503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308767995 | ||||||||
| FaxNumber: | 5308762159 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | NP9315 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | NP9315 | 01 | CA | LICENSE | OTHER |