Healthcare Provider Details

I. General information

NPI: 1790169852
Provider Name (Legal Business Name): KIMBERLY ANN SCHUELER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2015
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 W STEWART AVE STE 104
MEDFORD OR
97501-3663
US

IV. Provider business mailing address

229 W STEWART AVE STE 104
MEDFORD OR
97501-3663
US

V. Phone/Fax

Practice location:
  • Phone: 541-488-1116
  • Fax: 541-488-6409
Mailing address:
  • Phone: 541-488-1116
  • Fax: 541-488-6409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95002569
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: