MEDICARE: KB FAMILY PRACTICE, PLLC

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	261QH0100X	Health Service Clinic/Center	OP00001314	WA
2	363LF0000X	Family Nurse Practitioner	AP30006758	WA
3	207Q00000X	Family Medicine Physician	OP00001314	WA

General Provider Information

NPI Number	:	1386774578
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KB FAMILY PRACTICE, PLLC

Provider Business Mailing Address
First Line	:	408 LILLY RD NE STE B
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98506-6954
Country	:	US
Telephone Number	:	360-438-3029
Fax Number	:	360-438-8585

Provider Business Practice Location Address
First Line	:	408 LILLY RD NE STE B
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98506-6954
Country	:	US
Telephone Number	:	360-438-3029
Fax Number	:	360-438-8585

Authorized Official
Title or Position	:	CEO
Name	:	DR. K BURNELL SCHAETZEL-HILL
Credential	:	D.O.
Telephone Number	:	360-438-3029

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	07/21/2022

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