Provider Demographics
NPI:1982654158
Name:KAPPLER, KEVIN ANDREW (PHD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:ANDREW
Last Name:KAPPLER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:544 INNOCENT WAY
Mailing Address - Street 2:
Mailing Address - City:COPPEROPOLIS
Mailing Address - State:CA
Mailing Address - Zip Code:95228-9640
Mailing Address - Country:US
Mailing Address - Phone:209-768-8689
Mailing Address - Fax:206-680-0252
Practice Address - Street 1:544 INNOCENT WAY
Practice Address - Street 2:
Practice Address - City:COPPEROPOLIS
Practice Address - State:CA
Practice Address - Zip Code:95228-9640
Practice Address - Country:US
Practice Address - Phone:209-768-8689
Practice Address - Fax:206-680-0252
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9536103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPV0095360Medicaid
CA00PL95360Medicare ID - Type Unspecified