Provider Demographics
NPI:1114027513
Name:CAPPS, DEDRA L (CRNP)
Entity Type:Individual
Prefix:
First Name:DEDRA
Middle Name:L
Last Name:CAPPS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:DEDRA
Other - Middle Name:LEANN
Other - Last Name:THRASH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:PO BOX 649
Mailing Address - Street 2:
Mailing Address - City:RAINSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35986-0649
Mailing Address - Country:US
Mailing Address - Phone:256-638-9161
Mailing Address - Fax:256-638-9164
Practice Address - Street 1:504 MCCURDY AVE SOUTH
Practice Address - Street 2:SUITE
Practice Address - City:RAINSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35986-5254
Practice Address - Country:US
Practice Address - Phone:256-638-9161
Practice Address - Fax:256-638-9164
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-093350363LF0000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALP00695177OtherRR MEDICARE
DO6289OtherRR MEDICARE