Healthcare Provider Details

I. General information

NPI: 1992564736
Provider Name (Legal Business Name): BRIANNA SHAUNTE CAPEL RN, CEBP, MAED.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2024
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 CLEARVIEW DR
MADISONVILLE KY
42431-3420
US

IV. Provider business mailing address

701 CLEARVIEW DR
MADISONVILLE KY
42431-3420
US

V. Phone/Fax

Practice location:
  • Phone: 270-399-5969
  • Fax:
Mailing address:
  • Phone: 270-399-5969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number4008933
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code364SP0812X
TaxonomyCommunity Psychiatric/Mental Health Clinical Nurse Specialist
License Number4008933
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number4008933
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number4008933
License Number StateKY
# 5
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number4008933
License Number StateKY
# 6
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4008933
License Number StateKY
# 7
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number4008933
License Number StateKY
# 8
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number4008933
License Number StateKY
# 9
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number4008933
License Number StateKY
# 10
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNULL
# 11
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number4008933
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: