Healthcare Provider Details

I. General information

NPI: 1861908576
Provider Name (Legal Business Name): MATTHEW SCHULKE PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2017
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 DACY LN STE 120-130
KYLE TX
78640-4192
US

IV. Provider business mailing address

819 WATER ST
KERRVILLE TX
78028-5333
US

V. Phone/Fax

Practice location:
  • Phone: 512-392-8953
  • Fax: 512-262-7505
Mailing address:
  • Phone: 830-792-7505
  • Fax: 830-792-5771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number899253
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1175658
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: