Provider Demographics
NPI:1760621742
Name:SCHAUM, KIM L (FNP-BC)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:L
Last Name:SCHAUM
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-2124
Mailing Address - Country:US
Mailing Address - Phone:304-865-3600
Mailing Address - Fax:304-865-3700
Practice Address - Street 1:1212 GARFIELD AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-3247
Practice Address - Country:US
Practice Address - Phone:304-865-3600
Practice Address - Fax:304-865-3700
Is Sole Proprietor?:No
Enumeration Date:2009-02-13
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.10447-NP363LF0000X
WV49247363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810014361Medicaid
OH2929844Medicaid
OHNP29741Medicare PIN
OH2929844Medicaid