Provider Demographics
NPI:1043375090
Name:CAPELLO, KIMBERLY A (CNM)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:CAPELLO
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:A
Other - Last Name:BLANCHARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:59 OLD ROAD TO 9 ACRE COR
Mailing Address - Street 2:STE 1
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-3317
Mailing Address - Country:US
Mailing Address - Phone:978-371-0302
Mailing Address - Fax:
Practice Address - Street 1:59 OLD ROAD TO 9 ACRE COR
Practice Address - Street 2:STE 1
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-3317
Practice Address - Country:US
Practice Address - Phone:978-371-0302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA229918363L00000X, 363LW0102X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP3907Medicare PIN
MAP67243Medicare UPIN