Basic Information
| Provider Information | |||||||||
| NPI: | 1376761783 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHMEECKLE | ||||||||
| FirstName: | KELLIE | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4950 ESSEN LANE | ||||||||
| Address2: | ATTN: KRISTIE SIEMANN | ||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708093482 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252151311 | ||||||||
| FaxNumber: | 2252151380 | ||||||||
| Practice Location | |||||||||
| Address1: | 4950 ESSEN LANE | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708093482 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257671311 | ||||||||
| FaxNumber: | 2257671335 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2007 | ||||||||
| LastUpdateDate: | 04/07/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 025615 | LA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RX0202X | 025615 | LA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology | 207RH0003X | 25615 | LA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 025615 | 01 | LA | STATE LICENSE NUMBER | OTHER | 1043389 | 05 | LA | MEDICAID |