Provider Demographics
NPI:1053581827
Name:SCHEFFLER, SUSAN M (PA)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:SCHEFFLER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:M
Other - Last Name:KASCHALK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:10701 NALL AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1231
Mailing Address - Country:US
Mailing Address - Phone:913-381-5225
Mailing Address - Fax:913-901-0186
Practice Address - Street 1:10701 NALL AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1231
Practice Address - Country:US
Practice Address - Phone:913-381-5225
Practice Address - Fax:913-901-0186
Is Sole Proprietor?:No
Enumeration Date:2008-03-07
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-01232363A00000X
MO2008012518363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSP00616075OtherRR MEDICARE
KS39907018OtherBCBS
P21519Medicare UPIN
KSP00616075OtherRR MEDICARE