Provider Demographics
NPI:1881344604
Name:SCHILL, KELLY K (RN, FNP-C, AANP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:K
Last Name:SCHILL
Suffix:
Gender:F
Credentials:RN, FNP-C, AANP
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:K
Other - Last Name:SCHILL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2224 W VISTA BELLA DR
Mailing Address - Street 2:
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-2662
Mailing Address - Country:US
Mailing Address - Phone:414-218-4025
Mailing Address - Fax:
Practice Address - Street 1:949 N 9TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-1422
Practice Address - Country:US
Practice Address - Phone:800-367-5690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-25
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11844-33363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty