Provider Demographics
NPI:1447273255
Name:CAMPBELL, CATHIE N (DNP,PMHNP-BC,GNP-BC)
Entity type:Individual
Prefix:DR
First Name:CATHIE
Middle Name:N
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:DNP,PMHNP-BC,GNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521B 24TH AVE S STE 203
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-6775
Mailing Address - Country:US
Mailing Address - Phone:701-885-7920
Mailing Address - Fax:701-757-0859
Practice Address - Street 1:1521B 24TH AVE S STE 203
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-6775
Practice Address - Country:US
Practice Address - Phone:701-885-7920
Practice Address - Fax:701-757-0859
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR50899363LP0808X, 363LG0600X
TX539050363LG0600X
TXAP111274363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM54433819Medicaid
ND1482912Medicaid
TX153607009Medicaid
ID210880003Medicaid
TXNP8053OtherBCBS PROVIDER
TXNP8053OtherBCBS PROVIDER
TX301111YM6QMedicare PIN
TXNP8053OtherBCBS PROVIDER
TXP69363Medicare UPIN
TXNP0411Medicare ID - Type UnspecifiedMEDICARE PROVIDER
TXNP0412Medicare ID - Type UnspecifiedMEDICARE PROVIDER