Basic Information
Provider Information | |||||||||
NPI: | 1265435705 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CAPAN | ||||||||
FirstName: | JAY | ||||||||
MiddleName: | PATRICE | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | RN, PHCNS-BC | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 3537 S I-35 E | ||||||||
Address2: | SUITE 210 | ||||||||
City: | DENTON | ||||||||
State: | TX | ||||||||
PostalCode: | 762106800 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9403812313 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 3537 S I-35 E | ||||||||
Address2: | SUITE 210 | ||||||||
City: | DENTON | ||||||||
State: | TX | ||||||||
PostalCode: | 762106800 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9403812313 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/28/2005 | ||||||||
LastUpdateDate: | 01/29/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SC1501X | 242271 | TX | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Community Health/Public Health |
ID Information
ID | Type | State | Issuer | Description | 120096607 | 05 | TX |   | MEDICAID |