MEDICARE: KELSEY DIANE SCHMIDT

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	163W00000X	Registered Nurse	161162	IA
2	363LF0000X	Family Nurse Practitioner	A181218	IA

General Provider Information

NPI Number	:	1366286015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY DIANE SCHMIDT

Provider Business Mailing Address
First Line	:	2220 30TH ST
Second Line	:
City	:	SPIRIT LAKE
State	:	IA
Zip	:	51360-7576
Country	:	US
Telephone Number	:	605-354-2934
Fax Number	:

Provider Business Practice Location Address
First Line	:	2704 ENTERPRISE AVE
Second Line	:
City	:	SPIRIT LAKE
State	:	IA
Zip	:	51360-1073
Country	:	US
Telephone Number	:	712-336-2728
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2024
Last Update Date	:	09/10/2024

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