Healthcare Provider Details

I. General information

NPI: 1922818087
Provider Name (Legal Business Name): KIERSTIN SCHADE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2025
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 J D ANDERSON DR
MORGANTOWN WV
26505-3494
US

IV. Provider business mailing address

11 DELL DR
IRWIN PA
15642-4505
US

V. Phone/Fax

Practice location:
  • Phone: 304-598-1996
  • Fax:
Mailing address:
  • Phone: 724-961-5732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2994
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberMA066088
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: