Healthcare Provider Details

I. General information

NPI: 1952925448
Provider Name (Legal Business Name): JOHN KEVIN FITZPATRICK DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2020
Last Update Date: 07/27/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2817 REILLY RD
FORT BRAGG NC
28310-7301
US

IV. Provider business mailing address

2817 ROCK MERRITT AVE
FORT LIBERTY NC
28310-7301
US

V. Phone/Fax

Practice location:
  • Phone: 910-907-8246
  • Fax: 910-907-6870
Mailing address:
  • Phone: 910-907-8246
  • Fax: 910-907-6870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number2021-03020
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2021-03020
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: