Provider Demographics
NPI:1508946765
Name:SCHISLER, KATHRYN ANN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:ANN
Last Name:SCHISLER
Suffix:
Gender:F
Credentials:PA-C
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 70157
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-0021
Mailing Address - Country:US
Mailing Address - Phone:843-516-2024
Mailing Address - Fax:843-796-1319
Practice Address - Street 1:9021 BELLA VERDE CT
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-5110
Practice Address - Country:US
Practice Address - Phone:843-516-2024
Practice Address - Fax:843-796-1319
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601003952363A00000X
SC5011363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOZ96017OtherMEDICARE GROUP PTAN NUMBER
MIZ96017095Medicare PIN
MIOZ96017OtherMEDICARE GROUP PTAN NUMBER