Provider Demographics
NPI:1760587919
Name:SCHALCK, KRISTEN SUZANNE (PA)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:SUZANNE
Last Name:SCHALCK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:KRISTEN
Other - Middle Name:SUZANNE
Other - Last Name:MCRAE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:5920 WEST MALL
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-4232
Mailing Address - Country:US
Mailing Address - Phone:805-466-0676
Mailing Address - Fax:805-466-4862
Practice Address - Street 1:5920 WEST MALL
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422
Practice Address - Country:US
Practice Address - Phone:805-466-0676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA14416363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant