Healthcare Provider Details

I. General information

NPI: 1710931845
Provider Name (Legal Business Name): KARA MICHELLE PAINTON APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2512 HURST DR STE 120
MATTOON IL
61938-9200
US

IV. Provider business mailing address

611 W. PARK ST. BWPC
URBANA IL
61801-2500
US

V. Phone/Fax

Practice location:
  • Phone: 217-258-7590
  • Fax:
Mailing address:
  • Phone: 217-383-6792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209005779
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: