Provider Demographics
NPI:1063643922
Name:SCHULZE, KELLEY KENNEDY (PNP)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:KENNEDY
Last Name:SCHULZE
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:KELLEY
Other - Middle Name:JEANNE
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1500 UNIVERSITY DR E
Mailing Address - Street 2:#100
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77840-2600
Mailing Address - Country:US
Mailing Address - Phone:979-846-1100
Mailing Address - Fax:979-260-9390
Practice Address - Street 1:1651 ROCK PRAIRIE RD
Practice Address - Street 2:#102
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-8652
Practice Address - Country:US
Practice Address - Phone:979-693-7400
Practice Address - Fax:979-693-7446
Is Sole Proprietor?:No
Enumeration Date:2009-07-27
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX650862363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1275726853OtherCS CLINIC NPI
TX154467801Medicaid
TX1821185299OtherAGENCY NPI
TX1649265646OtherBRYAN-COLLEGE STATION CLINIC NPI
TX187842301Medicaid
TX1275726853OtherCS CLINIC NPI
TX671861Medicare Oscar/Certification