Healthcare Provider Details

I. General information

NPI: 1386189207
Provider Name (Legal Business Name): KAYLEE SCHOBELOCK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2017
Last Update Date: 06/15/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4437 STATE ROUTE 159 STE 125
CHILLICOTHEE OH
45601-7065
US

IV. Provider business mailing address

4437 STATE ROUTE 159
CHILLICOTHEE OH
45601-7065
US

V. Phone/Fax

Practice location:
  • Phone: 740-779-4570
  • Fax:
Mailing address:
  • Phone: 740-779-4570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.020212
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: