Provider Demographics
NPI:1164734117
Name:FITZPATRICK, KATHLEEN (ARNP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 CAPITOL WAY S # 116
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-1276
Mailing Address - Country:US
Mailing Address - Phone:404-620-6943
Mailing Address - Fax:
Practice Address - Street 1:DSHS BEHAVIORAL HEALTH & TREATMENT CENTER / MAPLE LANE
Practice Address - Street 2:20311 OLD HIGHWAY 9 SW
Practice Address - City:CENTRAILIA
Practice Address - State:WA
Practice Address - Zip Code:98531
Practice Address - Country:US
Practice Address - Phone:564-464-5419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-07
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAP 19129363LF0000X
MDR243137363LF0000X
GARN096592163W00000X
WAAP60353041363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse