Provider Demographics
NPI:1902247950
Name:SCHMIDT, ALISIA M (PA-C)
Entity Type:Individual
Prefix:
First Name:ALISIA
Middle Name:M
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALISIA
Other - Middle Name:M
Other - Last Name:KLOSTERMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 419059
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-9059
Mailing Address - Country:US
Mailing Address - Phone:182-777-5006
Mailing Address - Fax:618-277-4236
Practice Address - Street 1:4 PARK PL
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-2965
Practice Address - Country:US
Practice Address - Phone:618-277-7500
Practice Address - Fax:618-277-4236
Is Sole Proprietor?:No
Enumeration Date:2013-07-07
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.004678363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant