Provider Demographics
NPI:1316196751
Name:SCHWAGER, KELLY CATHERINE (NP-C)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:CATHERINE
Last Name:SCHWAGER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E HAYWARD ST
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64659-9201
Mailing Address - Country:US
Mailing Address - Phone:660-938-4213
Mailing Address - Fax:660-938-4211
Practice Address - Street 1:101 E HAYWARD ST
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:MO
Practice Address - Zip Code:64659-9201
Practice Address - Country:US
Practice Address - Phone:660-938-4213
Practice Address - Fax:660-938-4211
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-10
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001015706363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1316196751Medicaid
MO123990009Medicare PIN