Healthcare Provider Details

I. General information

NPI: 1306618327
Provider Name (Legal Business Name): KAYLEE DOUBET
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2023
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2811 HOMER ADAMS PKWY
ALTON IL
62002-4856
US

IV. Provider business mailing address

16177 E BLACKFOOT DR
CUBA IL
61427-9499
US

V. Phone/Fax

Practice location:
  • Phone: 618-465-5844
  • Fax:
Mailing address:
  • Phone: 309-634-9949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.305934
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: