=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457977274
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAYLA CRAIG FNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/17/2020
-----------------------------------------------------
Last Update Date | 09/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 163 E BETHALTO DR STE 300
-----------------------------------------------------
City | BETHALTO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62010-1801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-433-6490
-----------------------------------------------------
Fax | 618-433-6485
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 660 MASON RIDGE CENTER DR STE 300
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63141-8512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-448-3791
-----------------------------------------------------
Fax | 314-996-7658
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 041469330
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 209025199
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------