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Holly L Campbell

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

16611 S 40th St, Suite 180, Phoenix, AZ 85048

PECOS Enrollment

This provider is enrolled in PECOS as HOLLY CAMPBELL.

Based on the most recent information from CMS, provider Holly L Campbell is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 9:43 AM.

Profile Details

Provider ID
1225359946
Provider Type
Individual
Full Name
Campbell, Holly L
Credential
FNP-BC

Gender
Female
Sole Proprietor
No
Enumeration Date
6/16/2010
Last Updated
9/5/2018

Contact Information

Practice Location

16611 S 40th St, Suite 180, Phoenix, AZ 85048

(480) 785-2100

(480) 785-2111

Mailing Location

2545 W Frye Rd, Suite 9, Chandler, AZ 85224-6273

(480) 505-4258

(480) 275-8346

Provider Taxonomies

Code	Description	License
Code 363LF0000X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License AP3665 Arizona

Provider Identifiers

ID	Description	Issuer
ID 533427	Description Medicaid	Issuer Unlisted Arizona

Holly L Campbell

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

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