Healthcare Provider Details

I. General information

NPI: 1134363658
Provider Name (Legal Business Name): SALLIE FITZPATRICK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2009
Last Update Date: 02/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 JOEL DR BLANCHFIELD ARMY COMMUNITY HOSPITAL
FORT CAMPBELL KY
42223-5318
US

IV. Provider business mailing address

650 JOEL DR BLANCHFIELD ARMY COMMUNITY HOSPITAL
FORT CAMPBELL KY
42223-5318
US

V. Phone/Fax

Practice location:
  • Phone: 270-798-8242
  • Fax:
Mailing address:
  • Phone: 270-798-8242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number043850
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: