Provider Demographics
NPI:1376761783
Name:SCHMEECKLE, KELLIE D (MD)
Entity Type:Individual
Prefix:DR
First Name:KELLIE
Middle Name:D
Last Name:SCHMEECKLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4950 ESSEN LANE
Mailing Address - Street 2:ATTN: KRISTIE SIEMANN
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3482
Mailing Address - Country:US
Mailing Address - Phone:225-215-1311
Mailing Address - Fax:225-215-1380
Practice Address - Street 1:4950 ESSEN LANE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3482
Practice Address - Country:US
Practice Address - Phone:225-767-1311
Practice Address - Fax:225-767-1335
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA025615207RH0003X, 207RX0202X
LA25615207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA025615OtherSTATE LICENSE NUMBER
LA1043389Medicaid
LAF75955Medicare UPIN
LA1043389Medicaid