=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366864233
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KIMBERLY RUTH CAPPS CPNP-PC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/13/2014
-----------------------------------------------------
Last Update Date | 08/10/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2270 JOE BATTLE BLVD STE E-G
-----------------------------------------------------
City | EL PASO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79938-2609
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 915-642-9444
-----------------------------------------------------
Fax | 915-800-8570
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1201 E SHUSTER AVE BLDG # 4
-----------------------------------------------------
City | EL PASO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 915-642-9444
-----------------------------------------------------
Fax | 915-800-8570
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Nurse Practitioner
-----------------------------------------------------
License Number | 648487
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------