Provider Demographics
NPI:1588264493
Name:EGGEMEYER, KAILE JEAN
Entity type:Individual
Prefix:
First Name:KAILE
Middle Name:JEAN
Last Name:EGGEMEYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 NEIL ST
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:62233-2225
Mailing Address - Country:US
Mailing Address - Phone:618-615-1591
Mailing Address - Fax:
Practice Address - Street 1:1100 W DIANN LN
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-5339
Practice Address - Country:US
Practice Address - Phone:618-549-8006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-29
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209021695363LA2100X
MO2020019963363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care