Provider Demographics
NPI:1467865782
Name:CAPEL, KIM
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:CAPEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4510 PREMIER DR
Mailing Address - Street 2:SUITE 101-A
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-8349
Mailing Address - Country:US
Mailing Address - Phone:336-869-5000
Mailing Address - Fax:336-869-5044
Practice Address - Street 1:4510 PREMIER DRIVE
Practice Address - Street 2:SUITE 101-A
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-8350
Practice Address - Country:US
Practice Address - Phone:336-869-5000
Practice Address - Fax:336-869-5044
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9900552207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89129NWMedicaid
2336097Medicare PIN