Healthcare Provider Details

I. General information

NPI: 1417401985
Provider Name (Legal Business Name): KERRI JEAN SCHAFER APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2016
Last Update Date: 11/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 SPINDER DR
EAST PEORIA IL
61611-0016
US

IV. Provider business mailing address

PO BOX 960347
OKLAHOMA CITY OK
73196-0347
US

V. Phone/Fax

Practice location:
  • Phone: 309-308-5100
  • Fax: 309-308-5102
Mailing address:
  • Phone: 309-672-5522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209-014593
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: