Healthcare Provider Details

I. General information

NPI: 1750013314
Provider Name (Legal Business Name): DUSTIN D FORTNEY ACNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DUSTIN D FORTNEY APRN-ACNP

II. Dates (important events)

Enumeration Date: 06/30/2022
Last Update Date: 04/26/2024
Certification Date: 04/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 DIANA DR
WEBSTER SPRINGS WV
26288-9078
US

IV. Provider business mailing address

125 DIANA DR
WEBSTER SPRINGS WV
26288-9078
US

V. Phone/Fax

Practice location:
  • Phone: 304-847-5682
  • Fax:
Mailing address:
  • Phone: 304-847-5682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number113699
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: