Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0402X | Child Neurologist | 05-40252 | KS |
Y | 2084N0402X | Child Neurologist | 2017026480 | MO |
NPI | 1356606529 |
---|---|
Provider Name | Keely Fitzgerald |
First Address | Kansas City, MO 64108-4619 |
Second Address | Kansas City, MO 64108-4619 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2012 |
Last Update Date | 13/10/2017 |