Provider Demographics
NPI:1093286551
Name:SCHISLER, KEVIN THOMAS (FNP)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:THOMAS
Last Name:SCHISLER
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4215 15TH ST
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501-2523
Mailing Address - Country:US
Mailing Address - Phone:228-863-5211
Mailing Address - Fax:228-863-4041
Practice Address - Street 1:4215 15TH ST
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-2523
Practice Address - Country:US
Practice Address - Phone:228-284-0006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-10
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903009363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner