MEDICARE: MRS. KATELYN ELLEN STECHSCHULTE NP-C

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	RN.415162	OH
2	363L00000X	Nurse Practitioner	APRN.CNP.024011	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508321431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATELYN ELLEN STECHSCHULTE NP-C

Provider Business Mailing Address
First Line	:	1550 YANKEE PARK PL
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45458-1868
Country	:	US
Telephone Number	:	937-439-4949
Fax Number	:

Provider Business Practice Location Address
First Line	:	1550 YANKEE PARK PL
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45458-1868
Country	:	US
Telephone Number	:	937-439-4949
Fax Number	:

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

Provider Enumeration Date	:	02/05/2019
Last Update Date	:	03/29/2020

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