=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770847337
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATIE FITZPATRICK BOKELMAN D.O.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/28/2012
-----------------------------------------------------
Last Update Date | 11/16/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1000 W MORENO ST
-----------------------------------------------------
City | PENSACOLA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32501-2316
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-469-7406
-----------------------------------------------------
Fax | 850-478-1312
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1717 N E ST SUITE 227
-----------------------------------------------------
City | PENSACOLA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32501-6339
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-437-8600
-----------------------------------------------------
Fax | 850-437-8601
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208M00000X
-----------------------------------------------------
Taxonomy Name | Hospitalist Physician
-----------------------------------------------------
License Number | OS13914
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | OS 13914
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------