Provider Demographics
NPI:1750602439
Name:SCHIPPERS, KIM M (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KIM
Middle Name:M
Last Name:SCHIPPERS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 632
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-0632
Mailing Address - Country:US
Mailing Address - Phone:262-334-8339
Mailing Address - Fax:
Practice Address - Street 1:1110 OAK ST STE 1200
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-3876
Practice Address - Country:US
Practice Address - Phone:262-334-8339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-17
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI992-023363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical