Basic Information
| Provider Information | |||||||||
| NPI: | 1932166923 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHIBLER | ||||||||
| FirstName: | KELLY | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 MARSHLAND RD | ||||||||
| Address2: | |||||||||
| City: | HILTON HEAD ISLAND | ||||||||
| State: | SC | ||||||||
| PostalCode: | 299262305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8438426357 | ||||||||
| FaxNumber: | 8438426352 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 MARSHLAND RD | ||||||||
| Address2: | |||||||||
| City: | HILTON HEAD ISLAND | ||||||||
| State: | SC | ||||||||
| PostalCode: | 299262305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8438426357 | ||||||||
| FaxNumber: | 8438426352 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2006 | ||||||||
| LastUpdateDate: | 03/19/2015 | ||||||||
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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 | 207Q00000X | 34080 | SC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 34080 | 01 | SC | STATE LICENSE | OTHER | 0207387 | 05 | OH | MEDICAID |