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General NPI Number Information
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NPI Number | 1225814585
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Entity Type | Organization
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Legal Business Name | FORTITUDE PSYCHIATRY PLLC
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Dates
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Enumeration Date | 09/04/2023
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Last Update Date | 09/16/2025
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Provider Practice Location Address
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Address Line | 23403 E MISSION AVE STE 200D
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City | LIBERTY LAKE
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State | WA
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Zip | 99019-7575
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Country | US
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Telephone | 208-261-2501
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Fax | 877-935-2721
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Provider Business Mailing Address
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Address Line | 23403 E MISSION AVE STE 200D
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City | LIBERTY LAKE
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State | WA
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Zip | 99019-7575
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Country | US
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Telephone | 208-261-2501
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Fax | 877-935-2721
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Authorized Official
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Title or Position | ARNP
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Name | KAREY NEBO KANANDA
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Credential | PMHNP
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Telephone | 208-659-9382
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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