Healthcare Provider Details

I. General information

NPI: 1427300060
Provider Name (Legal Business Name): KIMBERLY SCHOENGART ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2012
Last Update Date: 10/14/2022
Certification Date: 10/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3512 STELLHORN RD
FORT WAYNE IN
46815-4631
US

IV. Provider business mailing address

PO BOX 392552
PITTSBURGH PA
15251-9500
US

V. Phone/Fax

Practice location:
  • Phone: 260-483-9081
  • Fax: 260-483-9196
Mailing address:
  • Phone: 260-483-9081
  • Fax: 260-483-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number71004155A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: