Basic Information
Provider Information
NPI: 1013250166
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CAPLE
FirstName: ANNETTE
MiddleName: DENISE
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: P O BOX 1000 DEPT 351
Address2:  
City: MEMPHIS
State: TN
PostalCode: 381480001
CountryCode: US
TelephoneNumber: 9017589900
FaxNumber: 9017522335
Practice Location
Address1: 1300 WESLEY DR
Address2:  
City: MEMPHIS
State: TN
PostalCode: 381166426
CountryCode: US
TelephoneNumber: 9013952618
FaxNumber: 9013853261
Other Information
ProviderEnumerationDate: 03/27/2013
LastUpdateDate: 10/05/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X0000017385TNY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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