Provider Demographics
NPI:1033632997
Name:SCHIMMOELLER, KAITLYN ALYSE (PA)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:ALYSE
Last Name:SCHIMMOELLER
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:
Other - Last Name:CHIOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1080 BEECHER XING N STE A
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43230-4577
Mailing Address - Country:US
Mailing Address - Phone:556-876-2278
Mailing Address - Fax:
Practice Address - Street 1:1080 BEECHER XING N STE A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43230-4577
Practice Address - Country:US
Practice Address - Phone:556-876-2278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-24
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AS0400X, 363A00000X
OH50.005251RX363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHTR951636OtherDRIVER LICENSE