Healthcare Provider Details

I. General information

NPI: 1588059430
Provider Name (Legal Business Name): KAITLYN MARIE PAINE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KAITLYN MARIE ALCORN MD

II. Dates (important events)

Enumeration Date: 03/30/2015
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1695 E RAINFOREST RD
FAYETTEVILLE AR
72703-5385
US

IV. Provider business mailing address

1695 E RAINFOREST RD
FAYETTEVILLE AR
72703-5385
US

V. Phone/Fax

Practice location:
  • Phone: 479-445-6460
  • Fax:
Mailing address:
  • Phone: 479-445-6460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number25MA11233000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number69381
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number312382
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberE-15817
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: