Provider Demographics
NPI:1174327449
Name:FITZGERALD, KRISTA DANIELLE (APRN)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:DANIELLE
Last Name:FITZGERALD
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W DIXIE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-1765
Mailing Address - Country:US
Mailing Address - Phone:270-982-0855
Mailing Address - Fax:
Practice Address - Street 1:300 W DIXIE AVE STE 200
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-1765
Practice Address - Country:US
Practice Address - Phone:270-982-0855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4031035363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health