Healthcare Provider Details

I. General information

NPI: 1457235319
Provider Name (Legal Business Name): KENNEDY SCHRATZ NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2025
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH ST STE BIW 6033
AUGUSTA GA
30912-0004
US

IV. Provider business mailing address

4348 QUAIL CREEK RD
AUGUSTA GA
30907-9733
US

V. Phone/Fax

Practice location:
  • Phone: 762-375-2286
  • Fax:
Mailing address:
  • Phone: 330-289-4414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberRN322816
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberRN322816
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: