MEDICARE: KATIE LYNN FITZPATRICK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	4704358653	MI

General Provider Information

NPI Number	:	1083559629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE LYNN FITZPATRICK

Provider Business Mailing Address
First Line	:	829 N CENTER AVE STE 230
Second Line	:
City	:	GAYLORD
State	:	MI
Zip	:	49735-1595
Country	:	US
Telephone Number	:	989-731-7930
Fax Number	:

Provider Business Practice Location Address
First Line	:	829 N CENTER AVE STE 230
Second Line	:
City	:	GAYLORD
State	:	MI
Zip	:	49735-1595
Country	:	US
Telephone Number	:	989-731-7930
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2026
Last Update Date	:	05/12/2026

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