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General NPI Number Information
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NPI Number | 1891591855
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Entity Type | Individual
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Provider Name | DENIKA FORTNER
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Gender | Female
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Dates
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Enumeration Date | 02/20/2025
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Last Update Date | 02/20/2025
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Provider Practice Location Address
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Address Line | 3003 LAKELAND CV
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City | FLOWOOD
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State | MS
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Zip | 39232-9504
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Country | US
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Telephone | 601-919-5269
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Fax |
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Provider Business Mailing Address
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Address Line | 4920 HANGING OAK DR
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City | JACKSON
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State | MS
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Zip | 39212-2111
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Country | US
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Telephone | 601-842-2233
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 1951
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License Number State | MS
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