Individual
MR. JOHN BRYCE FITZGERALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN, AGACNP-BC
Contact information
Practice address
3605 NORTHGATE CT, NEW ALBANY, IN 47150-6400
(812) 920-0408
Mailing address
4130 DUTCHMANS LN STE 300, LOUISVILLE, KY 40207-4710
(502) 897-1794
(502) 897-3852
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
28207179C
IN
363LA2100X
Acute Care Nurse Practitioner
28207179C
IN
363LG0600X
Gerontology Nurse Practitioner
28207179C
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100861520
—
KY
01
—
IN1920035
MEDICARE
IN
01
—
K4121802
MEDICARE
KY
Enumeration date
09/27/2022
Last updated
12/02/2022
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