MEDICARE: CASEY FITZPATRICK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program		WV
2	208000000X	Pediatrics Physician	55553	KY

General Provider Information

NPI Number	:	1376033878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASEY FITZPATRICK MD

Provider Business Mailing Address
First Line	:	793 EASTERN BYP STE 110
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-2425
Country	:	US
Telephone Number	:	859-624-2020
Fax Number	:

Provider Business Practice Location Address
First Line	:	793 EASTERN BYP STE 110
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-2425
Country	:	US
Telephone Number	:	859-624-2020
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2018
Last Update Date	:	06/14/2021

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Directions to “ CASEY FITZPATRICK MD” Practice Location

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