Provider Demographics
NPI:1023134863
Name:SCHOENBERGER, KYLE I (NP)
Entity type:Individual
Prefix:MR
First Name:KYLE
Middle Name:I
Last Name:SCHOENBERGER
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 WALTER ST NE STE 213
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2543
Mailing Address - Country:US
Mailing Address - Phone:505-727-7177
Mailing Address - Fax:
Practice Address - Street 1:500 WALTER ST NE STE 213
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2543
Practice Address - Country:US
Practice Address - Phone:505-727-7177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP01051208VP0014X, 363L00000X
WAAP30007611207P00000X
NMR44461363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMCNP01051OtherNM LICENSE
WA7036163Medicaid
NM4120701Medicaid
WAP74646Medicare UPIN
WA8869682Medicare PIN