Healthcare Provider Details

I. General information

NPI: 1639127731
Provider Name (Legal Business Name): KERRI R FITZGERALD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 06/11/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 BIRCHWOOD AVE STE 101
BELLINGHAM WA
98225-1720
US

IV. Provider business mailing address

2950 NEWMARKET ST STE 101-348
BELLINGHAM WA
98226-3872
US

V. Phone/Fax

Practice location:
  • Phone: 360-676-0922
  • Fax: 360-671-4726
Mailing address:
  • Phone: 360-389-7122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2004008958
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD00048775
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2004008958
Identifier TypeOTHER
Identifier StateMO
Identifier IssuerMO LICENSE
# 2
IdentifierMD00048775
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerWA LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: