Provider Demographics
NPI:1922501527
Name:SCHNEIDER, KACEY NOVIK (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:KACEY
Middle Name:NOVIK
Last Name:SCHNEIDER
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7071 FISH LAKE RD
Mailing Address - Street 2:
Mailing Address - City:HOLLY
Mailing Address - State:MI
Mailing Address - Zip Code:48442-9202
Mailing Address - Country:US
Mailing Address - Phone:248-212-2554
Mailing Address - Fax:
Practice Address - Street 1:5119 W BRISTOL RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-2966
Practice Address - Country:US
Practice Address - Phone:810-720-1510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-10
Last Update Date:2018-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI20173244363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics