Individual provider Active NPI

Kelly L Capobianco, FNP

  • Nurse Practitioner
  • Wilmington, NC
National Provider Identifier
1972843969
Registry record updated Apr 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
5006062 Issued in NC
Practice address
2421 Silver Stream LN
Wilmington, NC 28401-7684
Phone
(910) 341-3300
Fax
(910) 251-2067
NPI assigned
Feb 27, 2013
Last updated
Apr 14, 2016By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 14, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 5006062 NC Primary
Pediatric Nurse Practitioner 363LP0200X 5006062 NC

Addresses

Primary practice location

2421 Silver Stream LN
Wilmington, NC 28401-7684

Mailing address

2421 Silver Stream LN
Wilmington, NC 28401-7684
Phone (910) 341-3300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
5006062NCMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Hanover Pediatrics, Inc Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1361923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1460592000000",
    "number": "1972843969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2421 SILVER STREAM LN",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284017684",
            "telephone_number": "910-341-3300",
            "fax_number": "910-251-2067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2421 SILVER STREAM LN",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284017684",
            "telephone_number": "910-341-3300",
            "fax_number": "910-251-2067"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAPOBIANCO",
        "first_name": "KELLY",
        "middle_name": "L",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-02-27",
        "last_updated": "2016-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5006062",
            "primary": true
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NC",
            "license": "5006062",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.