Healthcare Provider Details

I. General information

NPI: 1154600583
Provider Name (Legal Business Name): ANDREA CAPPEL PORTER CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDREA KAY CAPPEL CNP

II. Dates (important events)

Enumeration Date: 08/16/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

547 E 11TH AVE
COLUMBUS OH
43211-2603
US

IV. Provider business mailing address

547 E 11TH AVE
COLUMBUS OH
43211-2603
US

V. Phone/Fax

Practice location:
  • Phone: 614-224-4506
  • Fax: 614-291-0118
Mailing address:
  • Phone: 614-224-4506
  • Fax: 614-291-0118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.12514
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.326657
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: