Provider Demographics
NPI:1982184768
Name:FITZSIMMONS, KATHLEEN KAY (BSN, RN)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:KAY
Last Name:FITZSIMMONS
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 6TH ST
Mailing Address - Street 2:
Mailing Address - City:TAFT
Mailing Address - State:CA
Mailing Address - Zip Code:93268-2306
Mailing Address - Country:US
Mailing Address - Phone:661-763-1521
Mailing Address - Fax:661-763-1495
Practice Address - Street 1:811 6TH ST
Practice Address - Street 2:
Practice Address - City:TAFT
Practice Address - State:CA
Practice Address - Zip Code:93268-2305
Practice Address - Country:US
Practice Address - Phone:661-763-3113
Practice Address - Fax:661-763-3732
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95071633163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool