Provider Demographics
NPI:1487844239
Name:FITZPATRICK, KRISTEN J (PA-C)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:J
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:42796 LILLEY POINTE DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-5324
Mailing Address - Country:US
Mailing Address - Phone:260-615-2970
Mailing Address - Fax:
Practice Address - Street 1:32669 WARREN RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-1677
Practice Address - Country:US
Practice Address - Phone:734-762-0798
Practice Address - Fax:734-762-6682
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2024-11-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MP00181800363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1487844239Medicaid