Provider Demographics
NPI:1265935282
Name:FITZGERALD, KATERI TRELLES (FNP)
Entity type:Individual
Prefix:
First Name:KATERI
Middle Name:TRELLES
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KATERI
Other - Middle Name:ANDREA
Other - Last Name:TRELLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:6220 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-8925
Mailing Address - Country:US
Mailing Address - Phone:269-276-4744
Mailing Address - Fax:
Practice Address - Street 1:6220 W MAIN ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-8925
Practice Address - Country:US
Practice Address - Phone:269-276-4744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-15
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704355385363L00000X
VA0024175945207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine