Provider Demographics
NPI:1811196108
Name:FITZPATRICK, KERRY ELIZABETH (LMP)
Entity Type:Individual
Prefix:MS
First Name:KERRY
Middle Name:ELIZABETH
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 641
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-0641
Mailing Address - Country:US
Mailing Address - Phone:253-226-1519
Mailing Address - Fax:
Practice Address - Street 1:1016 29TH ST NW
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1641
Practice Address - Country:US
Practice Address - Phone:253-226-1519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00012461174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist