Provider Demographics
NPI:1912957291
Name:SCHAFER, KIM (NP-C)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:SCHAFER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8411 WINDFORD WAY
Mailing Address - Street 2:
Mailing Address - City:ANTELOPE
Mailing Address - State:CA
Mailing Address - Zip Code:95843-5915
Mailing Address - Country:US
Mailing Address - Phone:916-727-2928
Mailing Address - Fax:
Practice Address - Street 1:2360 STOCKTON BLVD
Practice Address - Street 2:SUITE 1100
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2228
Practice Address - Country:US
Practice Address - Phone:916-734-3461
Practice Address - Fax:916-734-3591
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CARN468715163WP0200X
CA468715363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WP0200XNursing Service ProvidersRegistered NursePediatrics