Most Relevant Information
Provider Data
| NPI Number: | 1003415266 |
| Provider Name: | CHRISTIAN FORTENBERRY FNP |
| Entity Type: | Individual |
| Taxonomy Code: | 207Q00000X |
| Specialty: | Family Medicine |
| License Number: | 904008 |
Most Important Dates
| Enumeration Date: | 10/20/2020 |
| Last Updated: | 09/09/2022 |
Provider Practice Location
971 LAKELAND DR STE 557
JACKSON
MS
392164661
Practice Location Phone/Fax
| Phone: | 6012004560 |
| Fax: |
Provider Mailing Location
971 LAKELAND DR STE 557
JACKSON
MS
392164661
Provider Mailing Phone/Fax
| Phone: | 6012004560 |
| Fax: |
Suggested EMR
Family Practice EMR