Healthcare Provider Details

I. General information

NPI: 1225656424
Provider Name (Legal Business Name): KATELYN FORTENBERY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2020
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 FIELDSTOWN RD STE 124
GARDENDALE AL
35071-2418
US

IV. Provider business mailing address

201 DEFENSE HWY STE 260
ANNAPOLIS MD
21401-7096
US

V. Phone/Fax

Practice location:
  • Phone: 334-288-7808
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: