Active NPI
Kathleen Elaine Fitzgerald-Petersen, MSN, RN, WHNP-BC
- Women's Health Nurse Practitioner
- Xenia, OH
National Provider Identifier
1700908696
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Women's Health Nurse Practitioner
- License
- NP07736
- Practice address
- 360 Wilson Dr
Xenia, OH 45385-1810 - Phone
- (937) 374-5600
- NPI assigned
- Apr 4, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Women's Health Nurse Practitioner | 363LW0102X | NP07736 | OH | Primary |
Addresses
Primary practice location
360 Wilson Dr
Xenia, OH 45385-1810
Mailing address
360 Wilson Dr
Xenia, OH 45385-1810
Phone (937) 374-5600
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2776063 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science - Nursing, Nurse Practitioner, Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| NP07736 | OH | MD | Women's Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Clinton Memorial Hospital of Wilmington Clinton County Ohio | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Rural Acute Care Hospital
- Wilmington, OH
- NPI 1427064641
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175644800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1490832000000",
"number": "1700908696",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "360 WILSON DR",
"city": "XENIA",
"state": "OH",
"postal_code": "453851810",
"telephone_number": "937-374-5600"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "360 WILSON DR",
"city": "XENIA",
"state": "OH",
"postal_code": "453851810",
"telephone_number": "937-374-5600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FITZGERALD-PETERSEN",
"first_name": "KATHLEEN",
"middle_name": "ELAINE",
"name_prefix": "Ms.",
"credential": "MSN, RN, WHNP-BC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-04",
"last_updated": "2017-03-30",
"status": "A"
},
"taxonomies": [
{
"code": "363LW0102X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Women's Health",
"state": "OH",
"license": "NP07736",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2776063",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Xenia, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.