Provider Demographics
NPI:1881581874
Name:EDWARDS-CAMPBELL, KOURTNEY THIANNA
Entity type:Individual
Prefix:
First Name:KOURTNEY
Middle Name:THIANNA
Last Name:EDWARDS-CAMPBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 ORCHID ST APT 3408
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-7829
Mailing Address - Country:US
Mailing Address - Phone:646-256-8808
Mailing Address - Fax:646-256-8808
Practice Address - Street 1:3000 ORCHID ST
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-7791
Practice Address - Country:US
Practice Address - Phone:646-256-8808
Practice Address - Fax:646-256-8808
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program