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:F
Credentials:APRN, PNP-BC
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:400 MEDICAL PLZ STE 200
Mailing Address - Street 2:
Mailing Address - City:LAKE ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-1417
Mailing Address - Country:US
Mailing Address - Phone:636-591-1086
Mailing Address - Fax:636-625-1186
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:636-625-1186
Is Sole Proprietor?:No
Enumeration Date:2011-11-14
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2011037407363LP0200X
MO2008023068363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2008023068OtherMISSOURI STATE BOARD OF NURSING