Provider Demographics
NPI:1851778369
Name:CAPEHART, CHRISTY
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:
Last Name:CAPEHART
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 1:304 COUNTY ROAD 2006
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:TX
Mailing Address - Zip Code:75476-6205
Mailing Address - Country:US
Mailing Address - Phone:903-647-1382
Mailing Address - Fax:
Practice Address - Street 1:304 COUNTY ROAD 2006
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:TX
Practice Address - Zip Code:75476-6205
Practice Address - Country:US
Practice Address - Phone:903-647-1382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-04
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX302228164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse