Fitzgerald Primary Care LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

FITZGERALD PRIMARY CARE LLC

Practice address

2232 E Monument St
Baltimore, MD 21205-2431

Phone

(667) 207-3552

NPI assigned

May 29, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tarnisha Latasha Fitzgerald

Title

Owner

Phone

(443) 763-7154

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Fitzgerald Primary Care LLC

  • Primary Care Clinic/Center
  • Baltimore, MD
  • NPI 1902382252

  O20180802001242

  Same enrollment

Tax ID family

Fitzgerald Primary Care LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Fitzgerald Primary Care LLC

  • Primary Care Clinic/Center
  • Baltimore, MD
  • NPI 1902382252
  NPD tax ID

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kaddie Kallon

  • Psychiatric/Mental Health Nurse Practitioner
  • Laurel, MD
  • NPI 1427519404
  NPD
• Jennifer Margaret Laidley-Kelly, CRNP

  • Family Nurse Practitioner
  • Edgewood, MD
  • NPI 1518742949
  NPD
• Nicole Queen, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Parkville, MD
  • NPI 1073238846
  NPD
• Walter Lewis Toller III

  • Nurse Practitioner
  • Baltimore, MD
  • NPI 1760060636

  Psychiatric/Mental Health

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1685318400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715817600000",
    "number": "1033802848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2232 E MONUMENT ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212052431",
            "telephone_number": "667-207-3552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2232 E MONUMENT ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212052431",
            "telephone_number": "667-207-3552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FITZGERALD PRIMARY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-29",
        "last_updated": "2024-05-16",
        "certification_date": "2024-05-16",
        "status": "A",
        "authorized_official_last_name": "FITZGERALD",
        "authorized_official_first_name": "TARNISHA",
        "authorized_official_middle_name": "LATASHA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "443-763-7154"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leah J Fitchett, RDN
• Victor D. Fitterman, LCSW-C
• Maya Fitts
• Laurie Jean Fitz, PT
• Kelley Annette Fitzgerald Keyser, ASW
• Fitzgerald Primary Care LLC
• Jennifer Kumjae Fitzgerald
• Jennifer L Fitzgerald, MS, NNP-BC
• John Creighton Fitzgerald
• Meghan Fitzgerald, LCSW-C

• Psychiatric/Mental Health Nurse Practitioner in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Psychiatric/Mental Health Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.