Provider Demographics
NPI:1659195568
Name:CHAPLAIN, KILEY
Entity type:Individual
Prefix:
First Name:KILEY
Middle Name:
Last Name:CHAPLAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21191 SHAWNEETOWN RD
Mailing Address - Street 2:
Mailing Address - City:THOMPSONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62890-1035
Mailing Address - Country:US
Mailing Address - Phone:618-627-2019
Mailing Address - Fax:
Practice Address - Street 1:21191 SHAWNEETOWN RD
Practice Address - Street 2:
Practice Address - City:THOMPSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62890-1035
Practice Address - Country:US
Practice Address - Phone:618-627-2019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-08
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.423433163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse