Healthcare Provider Details

I. General information

NPI: 1003390659
Provider Name (Legal Business Name): HALI SCHULTHEISS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2018
Last Update Date: 02/23/2021
Certification Date: 02/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 W MAIN ST
CHERRYVALE KS
67335-1332
US

IV. Provider business mailing address

PO BOX 360
NEODESHA KS
66757-0360
US

V. Phone/Fax

Practice location:
  • Phone: 620-336-2131
  • Fax: 620-336-2237
Mailing address:
  • Phone: 620-336-2131
  • Fax: 620-336-2237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number78414
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: