Healthcare Provider Details

I. General information

NPI: 1982978532
Provider Name (Legal Business Name): LORI D FORTNER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/29/2012
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 LUZERNE ST
MOUNT IDA AR
71957-9437
US

IV. Provider business mailing address

PO BOX 21850
HOT SPRINGS AR
71903-1850
US

V. Phone/Fax

Practice location:
  • Phone: 870-867-2175
  • Fax: 479-234-4445
Mailing address:
  • Phone: 870-867-2175
  • Fax: 479-234-4445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA03657
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: