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NPI Code Detail

MEDICARE: NICHOLAS STEPHEN FORTNA DO

MEDICARE: NICHOLAS STEPHEN FORTNA DO
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
12084P0800XPsychiatry PhysicianSL2352NV
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1215739180
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICHOLAS STEPHEN FORTNA DO
Provider Business Mailing Address
First Line : 3014 W CHARLESTON BLVD STE 130
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-0083
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3014 W CHARLESTON BLVD STE 130
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-0083
Country : US
Telephone Number : 702-671-5127
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/24/2025
Last Update Date : 06/04/2026

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Directions to “ NICHOLAS STEPHEN FORTNA DO” Practice Location

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