Provider Demographics
NPI:1417401985
Name:SCHAFER, KERRI JEAN (APN)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:JEAN
Last Name:SCHAFER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 960347
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73196-0347
Mailing Address - Country:US
Mailing Address - Phone:309-672-5522
Mailing Address - Fax:
Practice Address - Street 1:133 SPINDER DR
Practice Address - Street 2:
Practice Address - City:EAST PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61611-0016
Practice Address - Country:US
Practice Address - Phone:309-308-5100
Practice Address - Fax:309-308-5102
Is Sole Proprietor?:No
Enumeration Date:2016-08-12
Last Update Date:2019-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-014593363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily