Provider Demographics
NPI:1083377063
Name:O'DAY, KAITLYN (APRN)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:O'DAY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:
Other - Last Name:ALLUMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:325 MAINE STREET
Mailing Address - Street 2:MSO LIBRARY
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044
Mailing Address - Country:US
Mailing Address - Phone:785-505-2988
Mailing Address - Fax:785-505-5228
Practice Address - Street 1:330 ARKANSAS ST STE 205
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-1485
Practice Address - Country:US
Practice Address - Phone:785-505-5045
Practice Address - Fax:785-505-5288
Is Sole Proprietor?:No
Enumeration Date:2021-10-18
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-80368363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS30004774980001Medicaid