Provider Demographics
NPI:1598911232
Name:SCHUCHARDT, KIMBERLY K (PA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:K
Last Name:SCHUCHARDT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2275 DEMING WAY
Mailing Address - Street 2:SUITE 240
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-5527
Mailing Address - Country:US
Mailing Address - Phone:608-662-7762
Mailing Address - Fax:
Practice Address - Street 1:2275 DEMING WAY
Practice Address - Street 2:SUITE 240
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-5527
Practice Address - Country:US
Practice Address - Phone:608-662-7762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI546-023363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical