Active NPI
Karen Fortune
- Speech-Language Pathologist
- Gonzales, TX
National Provider Identifier
1255799755
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 12005746
- Practice address
- 1110 N Sarah Dewitt Dr
Gonzales, TX 78629-3311 - Phone
- (830) 672-7581
- Fax
- (830) 672-8481
- NPI assigned
- Jan 29, 2016
- Last updated
- Jan 29, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 12005746 | TX | Primary |
Addresses
Primary practice location
1110 N Sarah Dewitt Dr
Gonzales, TX 78629-3311
Mailing address
1110 N Sarah Dewitt Dr
Gonzales, TX 78629-3311
Phone (830) 672-7581
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 12005746 | Other | TX | SPEACH-LANGUAGE PATHOLOGIST |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12005746 | TX | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1454025600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1454025600000",
"number": "1255799755",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1110 N SARAH DEWITT DR",
"city": "GONZALES",
"state": "TX",
"postal_code": "786293311",
"telephone_number": "830-672-7581",
"fax_number": "830-672-8481"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1110 N SARAH DEWITT DR",
"city": "GONZALES",
"state": "TX",
"postal_code": "786293311",
"telephone_number": "830-672-7581",
"fax_number": "830-672-8481"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FORTUNE",
"first_name": "KAREN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-01-29",
"last_updated": "2016-01-29",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "TX",
"license": "12005746",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SPEACH-LANGUAGE PATHOLOGIST",
"identifier": "12005746",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Gonzales, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.