Provider Demographics
NPI:1538472550
Name:SCHROEDER, SAMANTHA MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:MARIE
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22450 S HARRISON ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SPRING HILL
Mailing Address - State:KS
Mailing Address - Zip Code:66083-3151
Mailing Address - Country:US
Mailing Address - Phone:913-592-2720
Mailing Address - Fax:
Practice Address - Street 1:22450 S HARRISON ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SPRING HILL
Practice Address - State:KS
Practice Address - Zip Code:66083-3151
Practice Address - Country:US
Practice Address - Phone:913-592-2720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-19
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-01401363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS15-01401OtherKANSAS LICENSE