Healthcare Provider Details

I. General information

NPI: 1508799164
Provider Name (Legal Business Name): ABIGAIL ROSE KAPPENMAN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 N 1ST ST STE D220
SPRINGFIELD IL
62702-3757
US

IV. Provider business mailing address

PO BOX 19679
SPRINGFIELD IL
62794-9679
US

V. Phone/Fax

Practice location:
  • Phone: 217-545-8000
  • Fax: 217-545-2711
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number125.087895
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: