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NPI Code Detail

MEDICARE: MISS KIARA JO FORTUNE

MEDICARE: MISS KIARA JO FORTUNE
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
1225400000XRehabilitation PractitionerNC

General Provider Information

NPI Number : 1154506863
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS KIARA JO FORTUNE
Provider Business Mailing Address
First Line : 5421 HEATHER ST
Second Line :
City : HOPE MILLS
State : NC
Zip : 28348-2846
Country : US
Telephone Number : 910-423-0380
Fax Number :
Provider Business Practice Location Address
First Line : 325 N COOL SPRING ST
Second Line :
City : FAYETTEVILLE
State : NC
Zip : 28301-5137
Country : US
Telephone Number : 910-323-4925
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/02/2008
Last Update Date : 01/02/2008

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Directions to “ MISS KIARA JO FORTUNE ” Practice Location

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