Provider Demographics
NPI:1568453256
Name:SCHADLER, KELLY C (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:C
Last Name:SCHADLER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:C
Other - Last Name:POMPA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2649 SCHOENERSVILLE RD
Practice Address - Street 2:STE 301
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-7326
Practice Address - Country:US
Practice Address - Phone:610-866-2233
Practice Address - Fax:610-882-3474
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007600363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P83944Medicare UPIN
068087Medicare ID - Type Unspecified