Provider Demographics
NPI:1659850253
Name:KELLUM, CAPRICE (RN)
Entity Type:Individual
Prefix:
First Name:CAPRICE
Middle Name:
Last Name:KELLUM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1902 PROSPERITY TRL
Mailing Address - Street 2:
Mailing Address - City:MC GREGOR
Mailing Address - State:TX
Mailing Address - Zip Code:76657-4076
Mailing Address - Country:US
Mailing Address - Phone:254-412-8235
Mailing Address - Fax:
Practice Address - Street 1:201 COUNTY ROAD 3130
Practice Address - Street 2:
Practice Address - City:VALLEY MILLS
Practice Address - State:TX
Practice Address - Zip Code:76689-3421
Practice Address - Country:US
Practice Address - Phone:254-412-8235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-14
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health