Provider Demographics
NPI:1578632360
Name:SCHMIDGALL, KIMBERLY S (PA-C)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:S
Last Name:SCHMIDGALL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 VALLEY ST
Mailing Address - Street 2:
Mailing Address - City:MEDIAPOLIS
Mailing Address - State:IA
Mailing Address - Zip Code:52637-9491
Mailing Address - Country:US
Mailing Address - Phone:319-394-3568
Mailing Address - Fax:
Practice Address - Street 1:816 VALLEY ST
Practice Address - Street 2:
Practice Address - City:MEDIAPOLIS
Practice Address - State:IA
Practice Address - Zip Code:52637-9491
Practice Address - Country:US
Practice Address - Phone:319-394-3568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001298363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2150292Medicaid
IA2150292Medicaid
IAP10567Medicare UPIN