Provider Demographics
NPI:1992280549
Name:CAPPS, KELSEY LYNN (PA)
Entity type:Individual
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First Name:KELSEY
Middle Name:LYNN
Last Name:CAPPS
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Gender:F
Credentials:PA
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Mailing Address - Street 1:2900 CORPORATE WAY
Mailing Address - Street 2:DOOR D
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3925
Mailing Address - Country:US
Mailing Address - Phone:954-276-5685
Mailing Address - Fax:954-985-7074
Practice Address - Street 1:1150 N 35TH AVE STE 345
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021
Practice Address - Country:US
Practice Address - Phone:954-265-6300
Practice Address - Fax:954-961-3600
Is Sole Proprietor?:No
Enumeration Date:2018-09-29
Last Update Date:2021-03-16
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Provider Licenses
StateLicense IDTaxonomies
FL9111698363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant