MEDICARE: KELLIE FITZPATRICK CRNP

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	363LA2200X	Adult Health Nurse Practitioner	SP034482	PA
2	363LA2200X	Adult Health Nurse Practitioner	RN511318L	PA

General Provider Information

NPI Number	:	1467321133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLIE FITZPATRICK CRNP

Provider Business Mailing Address
First Line	:	12265 TOWNSEND RD
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19154-1201
Country	:	US
Telephone Number	:	215-671-9200
Fax Number	:

Provider Business Practice Location Address
First Line	:	12265 TOWNSEND RD
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19154-1201
Country	:	US
Telephone Number	:	215-671-9200
Fax Number	:

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

Provider Enumeration Date	:	11/01/2025
Last Update Date	:	05/02/2026

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