Audrey Lee Fortin, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

4289-22 Issued in MS

Practice address

989 Ellis Ave
Jackson, MS 39209-6256

Phone

(769) 235-3919

NPI assigned

Apr 12, 2021

Last updated

Jul 7, 2022By 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 2

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: yfortin@umc.edu

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

{
    "created_epoch": "1618185600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657152000000",
    "number": "1922688001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "649 MUIRWOOD CIR",
            "city": "RIDGELAND",
            "state": "MS",
            "postal_code": "391573623",
            "telephone_number": "662-560-7211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "989 ELLIS AVE",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392096256",
            "telephone_number": "769-235-3919"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "649 Muirwood Cir",
            "address_purpose": "LOCATION",
            "city": "Ridgeland",
            "state": "MS",
            "postal_code": "391573623",
            "country_code": "US",
            "telephone_number": "662-560-7211",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FORTIN",
        "first_name": "AUDREY",
        "middle_name": "LEE",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-04-12",
        "last_updated": "2022-07-07",
        "certification_date": "2022-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MS",
            "license": "4289-22",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "yfortin@umc.edu",
            "affiliation": "N",
            "endpointDescription": "Work email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "649 Muirwood Cir",
            "city": "Ridgeland",
            "state": "MS",
            "country_code": "US",
            "postal_code": "391573623",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "yfortin@umc.edu",
            "affiliation": "N",
            "address_1": "649 Muirwood Cir",
            "city": "Ridgeland",
            "state": "MS",
            "country_code": "US",
            "postal_code": "391573623",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Christian R Fortenberry, FNP
• Deborah Fortenberry, L.H.I.S
• Faith Fortenberry, DO
• Susan Cope Fortenberry, D.M.D.
• Anthony Lee Fortin, MD
• John Dudley Foss, M.D.
• Charity Foster
• Danielle Christine Foster, RN, MD
• Kristen Dawn Foster, FNP-C, AGACNP-BC
• Lagina Foster, M.D.

• General Practice Dentistry in Jackson, MS
• Providers in Jackson, MS by specialty
• General Practice Dentistry in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2022; 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.