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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

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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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