MEDICARE: KATHRYN ANN SCHNEIDER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	R0107138	OK
2	363LF0000X	Family Nurse Practitioner	200910	OK

General Provider Information

NPI Number	:	1235728163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN ANN SCHNEIDER

Provider Business Mailing Address
First Line	:	13029 BURLINGAME AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-8704
Country	:	US
Telephone Number	:	405-823-0506
Fax Number	:

Provider Business Practice Location Address
First Line	:	13029 BURLINGAME AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-8704
Country	:	US
Telephone Number	:	405-823-0506
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/14/2021
Last Update Date	:	04/12/2021

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Directions to “ KATHRYN ANN SCHNEIDER ” Practice Location

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