Healthcare Provider Details

I. General information

NPI: 1376367128
Provider Name (Legal Business Name): KALEE D. CAPPS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2024
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 BLACK GOLD BLVD
HAZARD KY
41701-2620
US

IV. Provider business mailing address

210 BLACK GOLD BLVD STE 106
HAZARD KY
41701-2620
US

V. Phone/Fax

Practice location:
  • Phone: 606-436-0711
  • Fax:
Mailing address:
  • Phone: 606-436-0711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA3513
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: