MEDICARE: MRS. KIMBERLY E FORTIER PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA9110538	FL
2	363AS0400X	Surgical Physician Assistant	9110538	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407044027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLY E FORTIER PA-C

Provider Business Mailing Address
First Line	:	PO BOX 95590
Second Line	:
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84095-0590
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 BAPTIST WAY STE 5C
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32503-2274
Country	:	US
Telephone Number	:	448-227-6820
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/09/2007
Last Update Date	:	03/09/2026

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