Healthcare Provider Details

I. General information

NPI: 1265908313
Provider Name (Legal Business Name): KATIE FORTENBERRY MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATIE LYNN FORTENBERRY

II. Dates (important events)

Enumeration Date: 10/16/2018
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 PRINCETON AVE SW STE 200F
BIRMINGHAM AL
35211-1321
US

IV. Provider business mailing address

3500 BLUE LAKE DR STE 495
VESTAVIA AL
35243-1975
US

V. Phone/Fax

Practice location:
  • Phone: 205-786-2776
  • Fax: 205-786-6227
Mailing address:
  • Phone: 800-257-6570
  • Fax: 205-599-4287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1-140000
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-140000
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: