Individual
KYLE FITZGERALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P. A
Contact information
Practice address
10512 S GLENSTONE PL, SUITE 102, BATON ROUGE, LA 70810-2966
(225) 757-6555
(225) 757-6179
Mailing address
10512 S GLENSTONE PL, SUITE 102, BATON ROUGE, LA 70810-2966
(225) 757-6555
(225) 757-6179
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA.200457
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2355007
—
LA
01
—
334144YNB7
MEDICARE PTAN
LA
Enumeration date
12/11/2013
Last updated
08/06/2015
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