Provider Demographics
NPI:1558765974
Name:FITZGERALD, KIMBERLY (FNP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5358 FIVE FORKS TRICKUM RD STE F
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087
Mailing Address - Country:US
Mailing Address - Phone:770-864-5020
Mailing Address - Fax:770-864-5025
Practice Address - Street 1:5358 FIVE FORKS TRICKUM RD STE F
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087
Practice Address - Country:US
Practice Address - Phone:770-864-5020
Practice Address - Fax:770-864-5025
Is Sole Proprietor?:No
Enumeration Date:2014-10-14
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN096945363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily