Healthcare Provider Details

I. General information

NPI: 1992099824
Provider Name (Legal Business Name): KENZIE A SCHEIDT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2011
Last Update Date: 10/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3311 RIVERBEND DR OREGON CARDIOLOGY
SPRINGFIELD OR
97477-8800
US

IV. Provider business mailing address

960 16TH ST 304
SPRINGFIELD OR
97477-4175
US

V. Phone/Fax

Practice location:
  • Phone: 541-484-4332
  • Fax:
Mailing address:
  • Phone: 541-744-6172
  • Fax: 541-744-8608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA154008
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: