Provider Demographics
NPI:1417913732
Name:FITZGERALD, AMY L (PA)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:L
Last Name:FITZGERALD
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 1:605 W LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:LINDSBORG
Mailing Address - State:KS
Mailing Address - Zip Code:67456
Mailing Address - Country:US
Mailing Address - Phone:785-227-3371
Mailing Address - Fax:785-227-3004
Practice Address - Street 1:605 W LINCOLN ST
Practice Address - Street 2:
Practice Address - City:LINDSBORG
Practice Address - State:KS
Practice Address - Zip Code:67456
Practice Address - Country:US
Practice Address - Phone:785-227-3371
Practice Address - Fax:785-227-3004
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-00369363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100004810IMedicaid