Provider Demographics
NPI:1184406043
Name:FITZPATRICK, KEITH
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:FITZPATRICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2403 OSAGE ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37208-2328
Mailing Address - Country:US
Mailing Address - Phone:615-209-0553
Mailing Address - Fax:
Practice Address - Street 1:2403 OSAGE ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37208-2328
Practice Address - Country:US
Practice Address - Phone:615-209-0553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-16
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNBLZ5804343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)