Healthcare Provider Details

I. General information

NPI: 1710313184
Provider Name (Legal Business Name): ASHLEY S KAYTOR-MCCOY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY S KAYTOR MD

II. Dates (important events)

Enumeration Date: 09/17/2013
Last Update Date: 01/23/2026
Certification Date: 01/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 E CHURCH ST STE B
BENTON IL
62812-2239
US

IV. Provider business mailing address

PO BOX 155
CHRISTOPHER IL
62822-0155
US

V. Phone/Fax

Practice location:
  • Phone: 618-435-9888
  • Fax: 618-435-9889
Mailing address:
  • Phone: 618-724-2401
  • Fax: 618-724-4628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036141299
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: