Healthcare Provider Details

I. General information

NPI: 1134996390
Provider Name (Legal Business Name): KELLY ALEEN SCHOON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2023
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 LINCOLNWAY
LA PORTE IN
46350-3105
US

IV. Provider business mailing address

1407 LINCOLNWAY
LA PORTE IN
46350-3105
US

V. Phone/Fax

Practice location:
  • Phone: 219-362-3446
  • Fax:
Mailing address:
  • Phone: 219-362-3446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71014725A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: