Healthcare Provider Details

I. General information

NPI: 1093579484
Provider Name (Legal Business Name): KATELYNN SCHUMACHER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATELYNN WEATHERLY

II. Dates (important events)

Enumeration Date: 02/07/2024
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2170 W IRONWOOD CENTER DR STE A
COEUR D ALENE ID
83814-2606
US

IV. Provider business mailing address

13987 N CASCADE ST
RATHDRUM ID
83858-8539
US

V. Phone/Fax

Practice location:
  • Phone: 208-665-5596
  • Fax:
Mailing address:
  • Phone: 208-503-0253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number78974
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number50320
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: