Provider Demographics
NPI:1992082325
Name:CAFAZZA, KAITLYN MARY (APRN, PNP-BC)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:MARY
Last Name:CAFAZZA
Suffix:
Gender:
Credentials:APRN, PNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 PERUQUE CROSSING CT
Mailing Address - Street 2:SUITE 101
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-2362
Mailing Address - Country:US
Mailing Address - Phone:636-294-5900
Mailing Address - Fax:636-294-5908
Practice Address - Street 1:400 MEDICAL PLZ STE 200
Practice Address - Street 2:
Practice Address - City:LAKE ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-1417
Practice Address - Country:US
Practice Address - Phone:636-625-2662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-14
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008023068363LP0200X
MO2011037407363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2008023068OtherMISSOURI STATE BOARD OF NURSING