1447211909 NPI number — MRS. SANDY K BURKES-CAMPBELL M.S., CCC-A

Table of content: MRS. SANDY K BURKES-CAMPBELL M.S., CCC-A (NPI 1447211909)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447211909 NPI number — MRS. SANDY K BURKES-CAMPBELL M.S., CCC-A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURKES-CAMPBELL
Provider First Name:
SANDY
Provider Middle Name:
K
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S., CCC-A
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BURKES-CAMPBELL
Provider Other First Name:
SANDRA
Provider Other Middle Name:
K
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS CCCA
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1447211909
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
703 THIMBLE SHOALS BLVD., C3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWPORT NEWS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23606-2576
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-873-8794
Provider Business Mailing Address Fax Number:
757-873-5794

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
703 THIMBLE SHOALS BLVD., C-3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWPORT NEWS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23606-2576
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-873-8794
Provider Business Practice Location Address Fax Number:
757-873-5794
Provider Enumeration Date:
03/31/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  2101000737 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 237600000X , with the licence number: 2101000737 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 231H00000X , with the licence number: 2201000471 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 250276 . This is a "BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 15482 . This is a "OPTIMA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 9451315 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".