Provider Demographics
NPI:1366521635
Name:PAIGE, KAILYN SUE (RP)
Entity type:Individual
Prefix:MRS
First Name:KAILYN
Middle Name:SUE
Last Name:PAIGE
Suffix:
Gender:F
Credentials:RP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4233 SPRINGVIEW DR
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-6513
Mailing Address - Country:US
Mailing Address - Phone:308-382-7574
Mailing Address - Fax:
Practice Address - Street 1:908 N HOWARD AVE STE 108
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-3529
Practice Address - Country:US
Practice Address - Phone:308-381-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10687183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE14170758350Medicaid
NE14170758350Medicaid