Provider Demographics
NPI:1639127731
Name:FITZGERALD, KERRI R (MD)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:R
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3720 VERNHARDSON ST
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98332-1059
Mailing Address - Country:US
Mailing Address - Phone:253-314-6112
Mailing Address - Fax:
Practice Address - Street 1:710 BIRCHWOOD AVE STE 101
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1720
Practice Address - Country:US
Practice Address - Phone:360-676-0922
Practice Address - Fax:360-671-4726
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004008958208000000X
WAMD00048775208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMD00048775OtherWA LICENSE
MO2004008958OtherMO LICENSE