Healthcare Provider Details

I. General information

NPI: 1982147500
Provider Name (Legal Business Name): TILLY SCHMIDT DNP, WHNP, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2016
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W WELSH ST
WILLIAMSBURG IA
52361-9485
US

IV. Provider business mailing address

300 W WELSH ST
WILLIAMSBURG IA
52361-9485
US

V. Phone/Fax

Practice location:
  • Phone: 319-660-0005
  • Fax:
Mailing address:
  • Phone: 319-660-0005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2015010522
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2024023335
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number115680
License Number StateNE
# 4
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number2016040786
License Number StateMO
# 5
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF179509
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: