Provider Demographics
NPI:1932576139
Name:CAPPS, CHARLES W III (FNP)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:W
Last Name:CAPPS
Suffix:III
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 S VICTORIA AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38732-3738
Mailing Address - Country:US
Mailing Address - Phone:662-402-1447
Mailing Address - Fax:
Practice Address - Street 1:515 S VICTORIA AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38732-3738
Practice Address - Country:US
Practice Address - Phone:662-402-1447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSRN890049363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily