Kayla Fortenberry, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

90639 Issued in TN

Practice address

1596 Highway 33 S
New Tazewell, TN 37825-7104

Phone

(423) 626-8271

Fax

(865) 342-0106

NPI assigned

Oct 12, 2021

Last updated

Oct 12, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1633996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633996800000",
    "number": "1750043311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1923 SULPHUR SPRINGS RD",
            "city": "MORRISTOWN",
            "state": "TN",
            "postal_code": "378135654",
            "telephone_number": "423-317-9344",
            "fax_number": "423-714-2355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1596 HIGHWAY 33 S",
            "city": "NEW TAZEWELL",
            "state": "TN",
            "postal_code": "378257104",
            "telephone_number": "423-626-8271",
            "fax_number": "865-342-0106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORTENBERRY",
        "first_name": "KAYLA",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-12",
        "last_updated": "2021-10-12",
        "certification_date": "2021-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "TN",
            "license": "90639",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wenda Leanne Epperson, PHARMD
• Russell Essary, PHARMD
• Bethany Joelle Evans, MA CCC-SLP
• Fast Pace Medical Clinic PLLC
• Fast Pace Medical Clinic PLLC
• April Dawn Fultz, R.N.
• Samantha Nicole Gent, CNA
• Melody Gilliam, R.N.
• Britney Monique Goins, PHARMD
• Bethany Nicole Good, LMSW

• Licensed Practical Nurse in New Tazewell, TN
• Providers in New Tazewell, TN by specialty
• Licensed Practical Nurse in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2021; 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.