Healthcare Provider Details

I. General information

NPI: 1558956755
Provider Name (Legal Business Name): KELLY MARIE SCHULTZ MSN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2021
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2272 N MAIN ST
CROWN POINT IN
46307-1802
US

IV. Provider business mailing address

2272 N MAIN ST
CROWN POINT IN
46307-1802
US

V. Phone/Fax

Practice location:
  • Phone: 219-661-5601
  • Fax:
Mailing address:
  • Phone: 219-661-5601
  • Fax: 574-485-1778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF02211054
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number710711025A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: