Provider Demographics
NPI:1578950101
Name:CASWELL, KAYLIE (WHNP-BC)
Entity Type:Individual
Prefix:
First Name:KAYLIE
Middle Name:
Last Name:CASWELL
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:KAYLIE
Other - Middle Name:
Other - Last Name:NEWTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:WHNP-BC
Mailing Address - Street 1:415 N 9TH ST
Mailing Address - Street 2:PO BOX 19640
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-5303
Mailing Address - Country:US
Mailing Address - Phone:217-545-8000
Mailing Address - Fax:
Practice Address - Street 1:1100 E LINCOLNSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-5950
Practice Address - Country:US
Practice Address - Phone:217-545-8000
Practice Address - Fax:217-529-5914
Is Sole Proprietor?:No
Enumeration Date:2015-04-21
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209012609363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL$$$$$$$$$001Medicaid
ILF400218855Medicare PIN