Provider Demographics
NPI:1699908871
Name:CAPPELLO, KAMI D (APRN - NNPBC)
Entity type:Individual
Prefix:MRS
First Name:KAMI
Middle Name:D
Last Name:CAPPELLO
Suffix:
Gender:F
Credentials:APRN - NNPBC
Other - Prefix:MISS
Other - First Name:KAMI
Other - Middle Name:D
Other - Last Name:HORNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2797
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-2797
Mailing Address - Country:US
Mailing Address - Phone:402-354-4230
Mailing Address - Fax:402-354-6171
Practice Address - Street 1:707 N 190TH PLZ
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-3974
Practice Address - Country:US
Practice Address - Phone:402-815-6428
Practice Address - Fax:402-815-1565
Is Sole Proprietor?:No
Enumeration Date:2009-09-03
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111042363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100258661-00Medicaid
IA16999J08871Medicaid
NE096573026Medicare PIN