Provider Demographics
NPI:1891536629
Name:FITZGERALD, KATELYN (PA-C)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1099 OHIO RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:SEWICKLEY
Mailing Address - State:PA
Mailing Address - Zip Code:15143-2056
Mailing Address - Country:US
Mailing Address - Phone:412-741-5670
Mailing Address - Fax:
Practice Address - Street 1:1099 OHIO RIVER BLVD
Practice Address - Street 2:
Practice Address - City:SEWICKLEY
Practice Address - State:PA
Practice Address - Zip Code:15143-2056
Practice Address - Country:US
Practice Address - Phone:412-741-5670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-05
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA065610363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
16309020OtherCAQH