Healthcare Provider Details

I. General information

NPI: 1386989218
Provider Name (Legal Business Name): RACHEL NICOLE FORTNEY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2012
Last Update Date: 06/22/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 S 84TH ST
OMAHA NE
68124-4056
US

IV. Provider business mailing address

102 WOODMONT BLVD STE 600
NASHVILLE TN
37205-5250
US

V. Phone/Fax

Practice location:
  • Phone: 531-895-9802
  • Fax:
Mailing address:
  • Phone: 615-315-5257
  • Fax: 615-692-0547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberJ148985
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number111440
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: