Provider Demographics
NPI:1851186258
Name:SCHOONOVER, MAKAILYN GRACE (PA-C)
Entity type:Individual
Prefix:
First Name:MAKAILYN
Middle Name:GRACE
Last Name:SCHOONOVER
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:MAKAILYN
Other - Middle Name:
Other - Last Name:MAIKRANZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1704 GRAND VILLA DR
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:KY
Mailing Address - Zip Code:40031-8956
Mailing Address - Country:US
Mailing Address - Phone:502-758-6119
Mailing Address - Fax:
Practice Address - Street 1:1023 NEW MOODY LN STE 102
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-9183
Practice Address - Country:US
Practice Address - Phone:502-222-0598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTC031363AS0400X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical