Provider Demographics
NPI:1952322497
Name:KAPSAR, PAUL J JR (APN)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:J
Last Name:KAPSAR
Suffix:JR
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4560 S EASTERN AVE STE 14
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-6182
Mailing Address - Country:US
Mailing Address - Phone:702-586-5060
Mailing Address - Fax:702-463-7377
Practice Address - Street 1:4560 S EASTERN AVE STE 14
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6182
Practice Address - Country:US
Practice Address - Phone:702-586-5060
Practice Address - Fax:702-463-7377
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP005949B363LF0000X
NVAPN000904363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
104928OtherFROM UMC
NV100512687Medicaid
PAQ14253Medicare UPIN
PA078162Medicare ID - Type UnspecifiedW/ ERMI