Provider Demographics
NPI:1861681108
Name:SCHULTE, KELLY L (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:L
Last Name:SCHULTE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7700 ORLY CT
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-6084
Mailing Address - Country:US
Mailing Address - Phone:214-998-8508
Mailing Address - Fax:
Practice Address - Street 1:7700 ORLY CT
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75025-6084
Practice Address - Country:US
Practice Address - Phone:214-998-8508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH09454363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000551861OtherANTHEM
OHSCNP26053Medicare PIN
OHSCNP26052Medicare PIN
000000551861OtherANTHEM