Provider Demographics
NPI:1972608503
Name:SCHRAG, DEBRA K (PA)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:K
Last Name:SCHRAG
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1107
Mailing Address - Street 2:
Mailing Address - City:ARKANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67005
Mailing Address - Country:US
Mailing Address - Phone:620-442-2500
Mailing Address - Fax:620-441-5971
Practice Address - Street 1:6401 PATTERSON PKWY
Practice Address - Street 2:
Practice Address - City:ARKANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:67005
Practice Address - Country:US
Practice Address - Phone:620-221-6100
Practice Address - Fax:620-221-7680
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1500707363AM0700X
KS15-00707363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100417480CMedicaid
KS004154001Medicare PIN
KS100417480CMedicaid