Healthcare Provider Details

I. General information

NPI: 1194207258
Provider Name (Legal Business Name): CAITLYN E GENET FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAITLYN E KARNS FNP

II. Dates (important events)

Enumeration Date: 09/05/2018
Last Update Date: 10/05/2022
Certification Date: 10/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1306 MAPLE ST
ELDORADO IL
62930
US

IV. Provider business mailing address

1201 PINE ST
ELDORADO IL
62930-1634
US

V. Phone/Fax

Practice location:
  • Phone: 618-273-9665
  • Fax: 618-273-2504
Mailing address:
  • Phone: 618-273-3361
  • Fax: 618-273-2504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.018000
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: