Provider Demographics
NPI:1891025169
Name:CAPDEVILA, KYLIE PERKINS (FNP)
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:PERKINS
Last Name:CAPDEVILA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KYLIE
Other - Middle Name:ANNE
Other - Last Name:PERKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 751461
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1461
Mailing Address - Country:US
Mailing Address - Phone:843-792-1414
Mailing Address - Fax:
Practice Address - Street 1:96 JONATHAN LUCAS ST
Practice Address - Street 2:CSB 903
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425-1461
Practice Address - Country:US
Practice Address - Phone:843-792-8177
Practice Address - Fax:843-792-0644
Is Sole Proprietor?:No
Enumeration Date:2010-01-08
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3886363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily