Mr Kevin Barry Fitzgerald, PA-C | |
915 Wisconsin Ave, Tieton, WA 98947-9802 | |
(509) 673-0044 | |
(509) 673-0054 |
Full Name | Mr Kevin Barry Fitzgerald |
---|---|
Gender | Male |
Speciality | Physician Assistant |
Location | 915 Wisconsin Ave, Tieton, Washington |
Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1548565682 | NPI | - | NPPES |
2040154 | Medicaid | WA | |
0419110 | Other | WA | LABOR AND INDUSTRIES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
363AM0700X | Physician Assistant - Medical | 2104 (Alaska) | Secondary |
363A00000X | Physician Assistant | PA60427970 (Washington) | Primary |
Mailing Address | Practice Location Address |
---|---|
Mr Kevin Barry Fitzgerald, PA-C 38555 St. John, Cir., Po Box 1068, Talkeetna, AK 99676 Ph: (907) 733-2704 | Mr Kevin Barry Fitzgerald, PA-C 915 Wisconsin Ave, Tieton, WA 98947-9802 Ph: (509) 673-0044 |
Jennifer Laura Broadt, PA Physician Assistant Medicare: Medicare Enrolled Practice Location: 915 Wisconsin Ave, Tieton, WA 98947 Phone: 509-673-0044 Fax: 509-673-0054 |