Provider Demographics
NPI:1265012538
Name:FITZGERALD, KAITLIN CASEY (NBC-HWC)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:CASEY
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:NBC-HWC
Other - Prefix:MRS
Other - First Name:KAITLIN
Other - Middle Name:
Other - Last Name:DAPORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NBC-HWC
Mailing Address - Street 1:738 CONDON DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-4704
Mailing Address - Country:US
Mailing Address - Phone:603-682-0079
Mailing Address - Fax:
Practice Address - Street 1:738 CONDON DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-4704
Practice Address - Country:US
Practice Address - Phone:603-682-0079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCA-3164305