Provider Demographics
NPI:1003540600
Name:FITZGERALD, JESSICA LEIGH (CASE MANAGER)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEIGH
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 STOKELY RD
Mailing Address - Street 2:
Mailing Address - City:CYNTHIANA
Mailing Address - State:KY
Mailing Address - Zip Code:41031-2104
Mailing Address - Country:US
Mailing Address - Phone:859-954-5150
Mailing Address - Fax:859-954-5160
Practice Address - Street 1:235 STOKELY RD
Practice Address - Street 2:
Practice Address - City:CYNTHIANA
Practice Address - State:KY
Practice Address - Zip Code:41031-2104
Practice Address - Country:US
Practice Address - Phone:859-954-5150
Practice Address - Fax:859-954-5160
Is Sole Proprietor?:No
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator