1356979645 NPI number — KAYLA CAMPBELL

Table of content: KAYLA CAMPBELL (NPI 1356979645)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356979645 NPI number — KAYLA CAMPBELL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAMPBELL
Provider First Name:
KAYLA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356979645
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/31/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2200 CASTLE ROCK
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDMOND
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73003-4775
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-659-5543
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
STEPHENSON CANCER CENTER
Provider Second Line Business Practice Location Address:
800 NE 10TH STREET
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-271-7559
Provider Business Practice Location Address Fax Number:
405-271-1360
Provider Enumeration Date:
03/31/2020

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: 133VN1301X , with the licence number:  550 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 133V00000X , with the licence number: 550 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 550 . This is a "STATE OF OKLAHOMA LISCESURE" identifier . This identifiers is of the category "OTHER".