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NPI Code Detail

MEDICARE: AUDREY FORTENBERRY

MEDICARE: AUDREY FORTENBERRY
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
1101Y00000XCounselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1164763280
Entity Type Code : Individual
Provider Name (Legal Business Name) : AUDREY FORTENBERRY
Provider Business Mailing Address
First Line : 1706 N SANTA FE AVE
Second Line :
City : TULSA
State : OK
Zip : 74127-2530
Country : US
Telephone Number : 918-527-8423
Fax Number :
Provider Business Practice Location Address
First Line : 1728 S CARSON AVE
Second Line :
City : TULSA
State : OK
Zip : 74119-4610
Country : US
Telephone Number : 918-607-3932
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2013
Last Update Date : 03/17/2018

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Directions to “ AUDREY FORTENBERRY ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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