Jackie Fortenberry, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

R114980 Issued in MS

Practice address

1225 N State St
Jackson, MS 39202-2064

Phone

(601) 968-1362

Fax

(601) 292-4592

NPI assigned

Feb 26, 2007

Last updated

Sep 6, 2026By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Mississippi Baptist Medical Center, Inc.

  dba MBMC - Neuro Hospitalists

  • Neurology Physician
  • Jackson, MS
  • NPI 1467589556
  NPD

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

{
    "created_epoch": "1172448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788652800000",
    "number": "1609902337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23090",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392253090",
            "telephone_number": "601-968-1362",
            "fax_number": "601-292-4592"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1225 N STATE ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392022064",
            "telephone_number": "601-968-1362",
            "fax_number": "601-292-4592"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORTENBERRY",
        "first_name": "JACKIE",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-26",
        "last_updated": "2026-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MS",
            "license": "R114980",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00117028",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Akeelein Forrest
• Amy Forsythe, N.P.
• Christian R Fortenberry, FNP
• Deborah Fortenberry, L.H.I.S
• Faith Fortenberry, DO
• Susan Cope Fortenberry, D.M.D.
• Anthony Lee Fortin, MD
• Audrey Lee Fortin, DMD
• John Dudley Foss, M.D.
• Charity Foster

• Certified Registered Nurse Anesthetist in Jackson, MS
• Providers in Jackson, MS by specialty
• Certified Registered Nurse Anesthetist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.