Provider Demographics
NPI:1588059430
Name:PAINE, KAITLYN MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:KAITLYN
Middle Name:MARIE
Last Name:PAINE
Suffix:
Gender:
Credentials:MD
Other - Prefix:DR
Other - First Name:KAITLYN
Other - Middle Name:MARIE
Other - Last Name:ALCORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1695 E RAINFOREST RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-5385
Mailing Address - Country:US
Mailing Address - Phone:479-445-6460
Mailing Address - Fax:
Practice Address - Street 1:1695 E RAINFOREST RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5385
Practice Address - Country:US
Practice Address - Phone:479-445-6460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-30
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA11233000208200000X
CT69381208200000X
NY312382208200000X
390200000X
ARE-15817208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program