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NPI Code Detail

MEDICARE: MISS JENIFER KAY FORTNEY PA-C

MEDICARE: MISS JENIFER KAY FORTNEY PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician Assistant10002104AIN

General Provider Information

NPI Number : 1073963351
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS JENIFER KAY FORTNEY PA-C
Provider Business Mailing Address
First Line : 5650 COVENTRY LN
Second Line :
City : FORT WAYNE
State : IN
Zip : 46804-7140
Country : US
Telephone Number : 217-508-8478
Fax Number :
Provider Business Practice Location Address
First Line : 5650 COVENTRY LN
Second Line :
City : FORT WAYNE
State : IN
Zip : 46804-7140
Country : US
Telephone Number : 217-508-8478
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2016
Last Update Date : 12/11/2019

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Directions to “ MISS JENIFER KAY FORTNEY PA-C” Practice Location

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