Charles Edward Fortenberry, R.N.

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

1-049601 Issued in AL

Practice address

1103 16TH Ave SE
Decatur, AL 35601-3595

Phone

(256) 350-0362

NPI assigned

Apr 18, 2007

Last updated

Oct 22, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse, Nurse Practitioner, Registered Nurse

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Island Medical Alabama LLC

  • Emergency Medicine Physician
  • Cullman, AL
  • NPI 1104097666
  NPD (past)
• North Alabama Emergency Physicians LLC

  • Emergency Medicine Physician
  • Sheffield, AL
  • NPI 1255378246
  NPD (past)
• Paragon Contracting Services LLC

  • Emergency Medicine Physician
  • Birmingham, AL
  • NPI 1225071459

  Nurse Practitioner

  NPD (past)
• Inphynet Contracting Services LLC

  • Emergency Medicine Physician
  • Delray Beach, FL
  • NPI 1073556767

  Nurse Practitioner

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193011200000",
    "number": "1023234648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1103 16TH AVE SE",
            "city": "DECATUR",
            "state": "AL",
            "postal_code": "356013595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1103 16TH AVE SE",
            "city": "DECATUR",
            "state": "AL",
            "postal_code": "356013595",
            "telephone_number": "256-350-0362"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORTENBERRY",
        "first_name": "CHARLES",
        "middle_name": "EDWARD",
        "credential": "R.N.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-18",
        "last_updated": "2007-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AL",
            "license": "1-049601",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD AL",
            "identifier": "51006076",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "891017506",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Teamber Fletcher
• Flinn Counseling and Consulting Dba Alex Farris Counseling
• For Doctors by Doctors LLC
• Shara L Ford, MS
• Angie Forman
• David A Francis, MD
• Erin Marie Friend, DPT
• Bridget Fulks, LPTA
• G. William Manifold, M.D., P.C.
• Mackenzie Gaddy, PHARMD

• Nurse Practitioner in Decatur, AL
• Providers in Decatur, AL by specialty
• Nurse Practitioner in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.