Basic Information
| Provider Information | |||||||||
| NPI: | 1417401985 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHAFER | ||||||||
| FirstName: | KERRI | ||||||||
| MiddleName: | JEAN | ||||||||
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| Credential: | APN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 960347 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731960347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3096725522 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 133 SPINDER DR | ||||||||
| Address2: | |||||||||
| City: | EAST PEORIA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 616110016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3093085100 | ||||||||
| FaxNumber: | 3093085102 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2016 | ||||||||
| LastUpdateDate: | 11/30/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 209-014593 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.