Basic Information
| Provider Information | |||||||||
| NPI: | 1366864233 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CAPPS | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | RUTH | ||||||||
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| Credential: | CPNP-PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1201 E SHUSTER AVE | ||||||||
| Address2: | BLDG # 4 | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 79902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9156429444 | ||||||||
| FaxNumber: | 9158008570 | ||||||||
| Practice Location | |||||||||
| Address1: | 2270 JOE BATTLE BLVD STE E-G | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799382609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9156429444 | ||||||||
| FaxNumber: | 9158008570 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2014 | ||||||||
| LastUpdateDate: | 08/10/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | 648487 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.