Healthcare Provider Details

I. General information

NPI: 1265499669
Provider Name (Legal Business Name): KELLI SCHAAR-EVISTON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 09/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5522 TAYLOR MILL RD
TAYLOR MILL KY
41015-4604
US

IV. Provider business mailing address

2300 CHAMBER CENTER DRIVE SUITE 200
FORT MITCHELL KY
41017-1673
US

V. Phone/Fax

Practice location:
  • Phone: 859-491-2855
  • Fax: 859-655-4395
Mailing address:
  • Phone: 859-344-5555
  • Fax: 859-655-4395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3003042
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1092435
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: