Active NPI
Kellie Jean Fortner, A.R.N.P.
- Family Nurse Practitioner
- St Augustine, FL
National Provider Identifier
1306190319
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- ARNP9266139
- Practice address
- 400 Health Park Blvd
Ste 300
St Augustine, FL 32086-5784 - Phone
- (904) 819-5155
- NPI assigned
- Oct 30, 2012
- Last updated
- Jun 17, 2013
- 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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | ARNP9266139 | FL | Primary |
Addresses
Primary practice location
400 Health Park Blvd
Ste 300
St Augustine, FL 32086-5784
Mailing address
400 Health Park Blvd
Ste 300
St Augustine, FL 32086-5784
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 008049800 | Medicaid | FL | |
| P01160791 | Other | FL | RAILROAD |
| Y0F42 | Other | FL | BCBS |
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)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| First City Hospitalists Group PLLC | Past | Accepting new patients | |
| Memorial Hospital Flagler Inc | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Hospitalist Physician
- St Augustine, FL
- NPI 1003053695
-
dba AdventHealth Palm Coast
- General Acute Care Hospital
- Palm Coast, FL
- NPI 1679678486
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1351555200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1371427200000",
"number": "1306190319",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "400 HEALTH PARK BLVD",
"address_2": "STE 300",
"city": "ST AUGUSTINE",
"state": "FL",
"postal_code": "320865784"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 HEALTH PARK BLVD",
"address_2": "STE 300",
"city": "ST AUGUSTINE",
"state": "FL",
"postal_code": "320865784",
"telephone_number": "904-819-5155"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FORTNER",
"first_name": "KELLIE",
"middle_name": "JEAN",
"credential": "A.R.N.P.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-10-30",
"last_updated": "2013-06-17",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "FL",
"license": "ARNP9266139",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "008049800",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD",
"identifier": "P01160791",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "Y0F42",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in St Augustine, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.