Doctor Name: | JENNIFER FORTSON |
NPI Number: | 1154798213 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CRNP |
License Number: | 1-100198 |
Business Practice Address: | 617 E Broad St Ste B Eufaula, AL - 360271710 |
Business Phone Number: | 3342327816 |
Business Fax Number: | 3346887127 |
Mailing Address: | 617 E Broad St Ste B, EUFAULA |
State: | AL |
Postal Code: | 360271710 |
Phone Number: | 3342327816 |
Fax Number: | 3346887127 |
NPI Enumeration Date: | 08/25/2015 |
NPI Last Update Date: | 04/13/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LP2300X |
License Number: | 1-100198 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |