Provider Demographics
NPI:1639175052
Name:CAPEHART, STEPHANIE KAY (PA-C)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:KAY
Last Name:CAPEHART
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:STEHANIE
Other - Middle Name:KAY
Other - Last Name:TALBOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3420 22ND PL
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1314
Mailing Address - Country:US
Mailing Address - Phone:806-725-5844
Mailing Address - Fax:806-723-6532
Practice Address - Street 1:4102 24TH ST
Practice Address - Street 2:STE. 403
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1806
Practice Address - Country:US
Practice Address - Phone:806-725-7150
Practice Address - Fax:806-723-6136
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04001363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX321200301Medicaid
TX8271NAOtherBLUE CROSS BLUE SHEILD
TX138110102OtherFIRSTCARE
NM56059531Medicaid
NM56059531Medicaid