Provider Demographics
NPI:1144389461
Name:BLACK CAPORALE, KYMBERLY (AP DOM)
Entity Type:Individual
Prefix:
First Name:KYMBERLY
Middle Name:
Last Name:BLACK CAPORALE
Suffix:
Gender:F
Credentials:AP DOM
Other - Prefix:
Other - First Name:M
Other - Middle Name:KIMBERLY
Other - Last Name:BLACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AP DOM
Mailing Address - Street 1:6161 DR MLK JR ST N
Mailing Address - Street 2:#201
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703
Mailing Address - Country:US
Mailing Address - Phone:727-521-0210
Mailing Address - Fax:727-521-0211
Practice Address - Street 1:6161 DR MLK JR ST N
Practice Address - Street 2:#201
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33703
Practice Address - Country:US
Practice Address - Phone:727-521-0210
Practice Address - Fax:727-521-0211
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 1348171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist