Healthcare Provider Details

I. General information

NPI: 1033022017
Provider Name (Legal Business Name): KELSIE FITZPATRICK
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

834 SHERIDAN ST
PORT TOWNSEND WA
98368-2443
US

IV. Provider business mailing address

PO BOX 421
CHIMACUM WA
98325-0421
US

V. Phone/Fax

Practice location:
  • Phone: 360-385-2200
  • Fax:
Mailing address:
  • Phone: 360-385-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.RN.70057225.MSL
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: