Healthcare Provider Details

I. General information

NPI: 1275357121
Provider Name (Legal Business Name): BRENTENEY FORTUNE FNP-C, CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2024
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 MILITARY ST S
HAMILTON AL
35570-6611
US

IV. Provider business mailing address

1911 MILITARY ST S
HAMILTON AL
35570-6611
US

V. Phone/Fax

Practice location:
  • Phone: 205-952-9603
  • Fax:
Mailing address:
  • Phone: 205-952-9603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number908070
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3-002837
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: