Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 44395 | KY |
Y | 2080P0204X | Pediatric Emergency Doctor | 44395 | KY |
NPI | 1023228277 |
---|---|
Provider Name | Dr. Kerry S Caperell |
First Address | Louisville, KY 40201-0909 |
Second Address | Louisville, KY 40202-1821 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 04/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201027630 | (05) | IN |
7100164380 | (05) | KY |