Provider Demographics
NPI:1134113350
Name:FITZPATRICK, KIMBERLY J (CRNA)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:J
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5529 SHADYBROOK DR
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-6508
Mailing Address - Country:US
Mailing Address - Phone:814-835-2298
Mailing Address - Fax:
Practice Address - Street 1:2893 N RIDGE EAST
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-4134
Practice Address - Country:US
Practice Address - Phone:814-835-2298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN252145L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2309988Medicaid
OHP00461234OtherRAILROAD MEDICARE
OHP00461234OtherRAILROAD MEDICARE
OHH155591Medicare PIN
OH2309988Medicaid
OHFI8237221Medicare PIN
PA156070YE6SMedicare PIN