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NPI Code Detail

MEDICARE: MISTY KAY FORTNER PA-C

MEDICARE: MISTY KAY FORTNER 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
1363A00000XPhysician AssistantPA07530TX

General Provider Information

NPI Number : 1609152776
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISTY KAY FORTNER PA-C
Provider Business Mailing Address
First Line : 5220 80TH ST
Second Line :
City : LUBBOCK
State : TX
Zip : 79424-2862
Country : US
Telephone Number : 806-771-2400
Fax Number : 806-771-7760
Provider Business Practice Location Address
First Line : 5220 80TH ST
Second Line :
City : LUBBOCK
State : TX
Zip : 79424-2862
Country : US
Telephone Number : 806-771-2400
Fax Number : 806-771-7760
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2011
Last Update Date : 06/26/2025

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Directions to “ MISTY KAY FORTNER PA-C” Practice Location

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