Provider Demographics
NPI:1902468721
Name:SCHAFFITZEL, RACHAEL NICOLE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:RACHAEL
Middle Name:NICOLE
Last Name:SCHAFFITZEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:RACHAEL
Other - Middle Name:NICOLE
Other - Last Name:KERRIGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 4046
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65808-4046
Mailing Address - Country:US
Mailing Address - Phone:417-269-5712
Mailing Address - Fax:417-269-7567
Practice Address - Street 1:3805 S KANSAS EXPY STE B
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-6989
Practice Address - Country:US
Practice Address - Phone:417-269-0269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-01
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019024358363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant