Healthcare Provider Details

I. General information

NPI: 1720632508
Provider Name (Legal Business Name): KAITLIN ELIZABETH BEHNKEN APRN, DNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2019
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 W OAK ST
CARBONDALE IL
62901-1464
US

IV. Provider business mailing address

PO BOX 3988
CARBONDALE IL
62902-3988
US

V. Phone/Fax

Practice location:
  • Phone: 618-529-4455
  • Fax: 618-351-1287
Mailing address:
  • Phone: 618-529-4455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209019674
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number209019674
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: