Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | LA | |
N | 225000000X | Orthotic Fitter | LA |
NPI | 1992849780 |
---|---|
Provider Name | Mr. Kevin Scott Campbell SR. |
First Address | Bogalusa, LA 70427 |
Second Address | Bogalusa, LA 70427 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2007 |
Last Update Date | 16/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00440994 | (05) | MS |
1561312 | (05) | LA |
7214531530 | BLUE CROSS BLUE SHIELD (01) | LA |
7214531530 | BLUE CROSS BLUE SHIELD (01) | MS |