Healthcare Provider Details

I. General information

NPI: 1255972980
Provider Name (Legal Business Name): KECIA MARIE SCHWARZKOPF MSN, RN, AGPCNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2019
Last Update Date: 02/02/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11725 ILLINOIS ST STE 350
CARMEL IN
46032-3009
US

IV. Provider business mailing address

3361 PAISLEY POINTE
WHITESTOWN IN
46075-9780
US

V. Phone/Fax

Practice location:
  • Phone: 317-688-2831
  • Fax:
Mailing address:
  • Phone: 815-954-7538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number71009446A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71009446A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: