Provider Demographics
NPI: | 1992564736 |
---|---|
Name: | CAPEL, BRIANNA SHAUNTE (RN, CEBP, MAED) |
Entity type: | Individual |
Prefix: | MS |
First Name: | BRIANNA |
Middle Name: | SHAUNTE |
Last Name: | CAPEL |
Suffix: | |
Gender: | F |
Credentials: | RN, CEBP, MAED |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 701 CLEARVIEW DR |
Mailing Address - Street 2: | |
Mailing Address - City: | MADISONVILLE |
Mailing Address - State: | KY |
Mailing Address - Zip Code: | 42431-3420 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 270-399-5969 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 701 CLEARVIEW DR |
Practice Address - Street 2: | |
Practice Address - City: | MADISONVILLE |
Practice Address - State: | KY |
Practice Address - Zip Code: | 42431-3420 |
Practice Address - Country: | US |
Practice Address - Phone: | 270-399-5969 |
Practice Address - Fax: | |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2024-03-14 |
Last Update Date: | 2024-11-15 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
KY | 4008933 | 171000000X, 251C00000X, 251S00000X, 364SP0812X, 373H00000X, 385HR2055X, 163W00000X, 385HR2060X, 163WC1500X, 163WP0807X |
252Y00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 163W00000X | Nursing Service Providers | Registered Nurse | Group - Multi-Specialty | |
No | 171000000X | Other Service Providers | Military Health Care Provider | ||
No | 251C00000X | Agencies | Day Training, Developmentally Disabled Services | ||
No | 251S00000X | Agencies | Community/Behavioral Health | ||
No | 252Y00000X | Agencies | Early Intervention Provider Agency | ||
No | 364SP0812X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health, Community | |
No | 373H00000X | Nursing Service Related Providers | Day Training/Habilitation Specialist | ||
No | 385HR2055X | Respite Care Facility | Respite Care | Respite Care, Mental Illness, Child | |
No | 385HR2060X | Respite Care Facility | Respite Care | Respite Care, Intellectual and/or Developmental Disabilities, Child | |
No | 163WC1500X | Nursing Service Providers | Registered Nurse | Community Health | Group - Multi-Specialty |
No | 163WP0807X | Nursing Service Providers | Registered Nurse | Psychiatric/Mental Health, Child & Adolescent |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
KY | 4008933 | Other | KBN |