Provider Demographics
NPI:1003415266
Name:FORTENBERRY, CHRISTIAN (FNP)
Entity type:Individual
Prefix:MRS
First Name:CHRISTIAN
Middle Name:
Last Name:FORTENBERRY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:601-200-4560
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:971 LAKELAND DR STE 557
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4661
Practice Address - Country:US
Practice Address - Phone:601-200-4560
Practice Address - Fax:601-200-4580
Is Sole Proprietor?:No
Enumeration Date:2020-10-20
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904008363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily