Provider Demographics
NPI:1538409396
Name:YENRICK, KELLIE K (PA-C)
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:K
Last Name:YENRICK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KELLIE
Other - Middle Name:K
Other - Last Name:SCHOENLEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2940 N MCCORD RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-1753
Mailing Address - Country:US
Mailing Address - Phone:419-842-3000
Mailing Address - Fax:419-842-3042
Practice Address - Street 1:2940 N MCCORD RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-1753
Practice Address - Country:US
Practice Address - Phone:419-842-3000
Practice Address - Fax:419-842-3042
Is Sole Proprietor?:No
Enumeration Date:2013-02-15
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601006693363A00000X
OH50003712363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0080158Medicaid
OHH171130Medicare PIN