Provider Demographics
NPI:1003407321
Name:SCHAUSS, KYLA M (FNP)
Entity Type:Individual
Prefix:
First Name:KYLA
Middle Name:M
Last Name:SCHAUSS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 W MCKINLEY AVE STE D
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-5592
Mailing Address - Country:US
Mailing Address - Phone:574-282-3230
Mailing Address - Fax:574-282-3240
Practice Address - Street 1:413 W MCKINLEY AVE STE D
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-5592
Practice Address - Country:US
Practice Address - Phone:574-282-3230
Practice Address - Fax:574-282-3240
Is Sole Proprietor?:No
Enumeration Date:2021-01-29
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71010881A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300048497Medicaid
IN200817480AMedicaid