1144389461 NPI number — KYMBERLY BLACK CAPORALE AP DOM

Table of content: KYMBERLY BLACK CAPORALE AP DOM (NPI 1144389461)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144389461 NPI number — KYMBERLY BLACK CAPORALE AP DOM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLACK CAPORALE
Provider First Name:
KYMBERLY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
AP DOM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BLACK
Provider Other First Name:
M
Provider Other Middle Name:
KIMBERLY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
AP DOM
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1144389461
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6161 DR MLK JR ST N
Provider Second Line Business Mailing Address:
#201
Provider Business Mailing Address City Name:
SAINT PETERSBURG
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-521-0210
Provider Business Mailing Address Fax Number:
727-521-0211

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6161 DR MLK JR ST N
Provider Second Line Business Practice Location Address:
#201
Provider Business Practice Location Address City Name:
SAINT PETERSBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-521-0210
Provider Business Practice Location Address Fax Number:
727-521-0211
Provider Enumeration Date:
12/06/2006

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: 171100000X , with the licence number:  AP 1348 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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