Provider Demographics
NPI:1588186084
Name:DESPAIN, CAITLEN ELIZABETH (FNP-BC)
Entity Type:Individual
Prefix:
First Name:CAITLEN
Middle Name:ELIZABETH
Last Name:DESPAIN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 N WESTGATE AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62650-1152
Mailing Address - Country:US
Mailing Address - Phone:217-243-8455
Mailing Address - Fax:217-243-7951
Practice Address - Street 1:610 N WESTGATE AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62650-1152
Practice Address - Country:US
Practice Address - Phone:217-243-8455
Practice Address - Fax:217-243-7951
Is Sole Proprietor?:No
Enumeration Date:2017-07-17
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-016174363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209-016174OtherSTATE LICENSE