MEDICARE: KRISTEN SCHELL PHOTOGRAPHY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374J00000X	Doula

General Provider Information

NPI Number	:	1245075803
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KRISTEN SCHELL PHOTOGRAPHY LLC

Provider Business Mailing Address
First Line	:	156 W MICHIGAN AVE UNIT 295
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49201-1302
Country	:	US
Telephone Number	:	724-884-5310
Fax Number	:

Provider Business Practice Location Address
First Line	:	810 S WEST AVE
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49203-1667
Country	:	US
Telephone Number	:	724-884-5310
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KRISTEN SCHELL
Credential	:
Telephone Number	:	724-884-5310

Provider Enumeration Date	:	06/26/2024
Last Update Date	:	10/16/2024

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