Provider Demographics
NPI:1376934992
Name:FITZPATRICK, KANITRA RASHEEN (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:KANITRA
Middle Name:RASHEEN
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:KANITRA
Other - Middle Name:RASHEEN
Other - Last Name:MCRAE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:4700 WISSAHICKON AVE STE 118
Mailing Address - Street 2:D
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-4248
Mailing Address - Country:US
Mailing Address - Phone:267-597-3600
Mailing Address - Fax:
Practice Address - Street 1:4700 WISSAHICKON AVE STE 118
Practice Address - Street 2:D
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-4248
Practice Address - Country:US
Practice Address - Phone:267-597-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-18
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP014745363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily