CHARLES EDWARD FORTENBERRY (NPI# 1023234648) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023234648 |
| Entity Type | Individual |
| Full Name | CHARLES EDWARD FORTENBERRY |
| Credential | R.N. |
| Practice Address |
1103 16th Ave Se Decatur AL 35601-3595 |
| Practice Telephone | 2563500362 |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2007-10-22 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363L00000X | Nurse Practitioner | 1-049601 | AL | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AL | BLUE CROSS BLUE SHIELD AL | 51006076 | 01 |
| AL | 891017506 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013923432 | Charles Steven Fortenberry | Dentist | 7737 Southwest Fwy, Suite 960, Houston, TX 77074-1807 | 2006-07-31 |
| Street Address |
1103 16TH AVE SE |
| City | DECATUR |
| State | AL |
| Zip Code | 35601-3595 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104904903 | Phillip Shannon Farris | Physician Assistant | 1103 16th Ave Se, Decatur, AL 35601-3595 | 2006-11-01 |
| 1962036665 | Krista Butts | Nurse Practitioner | 1103 16th Ave Se, Decatur, AL 35601-3595 | 2020-03-03 |
| 1295240588 | Eric Todd Smith | Technician/Technologist | 1103 16th Ave Se, Decatur, AL 35601-3595 | 2017-12-07 |
| 1679095699 | Jeremy Keith Urban | Nurse Practitioner | 1103 16th Ave Se, Decatur, AL 35601 | 2017-07-11 |
| 1699169474 | Nicholas Krishnan | Physician Assistant | 1103 16th Ave Se, Decatur, AL 35601-3595 | 2015-03-19 |
| 1841633187 | Justin David Hallock | Orthopaedic Surgery | 1103 16th Ave Se, Decatur, AL 35601-3595 | 2013-04-16 |
| 1073854626 | Meghan Pace Hollimon | Nurse Practitioner | 1103 16th Ave Se, Decatur, AL 35601-3595 | 2013-03-06 |
| 1902045867 | Janice D Draper | Physical Therapist | 1103 16th Ave Se, Decatur, AL 35601-3595 | 2009-02-16 |
| 1215198007 | Justin L Daigre | Specialist | 1103 16th Ave Se, Decatur, AL 35601-3595 | 2008-06-24 |
| 1740331347 | Decatur Orthopaedic Clinic, LLC | Physical Medicine & Rehabilitation | 1103 16th Ave Se, Decatur, AL 35601-3595 | 2007-01-12 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376000679 | Monica Dawn Ross | Counselor | 106 Lee St. Ne, Suite C, Decatur, AL 35601 | 2019-02-23 |
| 1063950319 | Samantha Elizabeth Pickett | Nurse Practitioner | 1115 Beltline Rd Se, Ste 400, Decatur, AL 35601 | 2017-02-07 |
| 1497208250 | Beronica Goodwin | Home Health Aide | 1102b Suite #2 4th Ave Se, Decatur, AL 35601 | 2016-07-28 |
| 1770957177 | Xochitl Dupre | Obstetrics & Gynecology | 1874 Beltline Road Sw, Suite 105, Decatur, AL 35601 | 2015-11-23 |
| 1104224708 | River City Psychiatry, Inc. | Community/Behavioral Health | 115 Johnston Street, Se, Suite 202, Decatur, AL 35601 | 2014-12-12 |
| 1760882690 | Derrick Aaron Randolph | Registered Nurse | 1207 7th St S.e., Decatur/morgan Hospital - Parkway Campus, Decatur, GA 35601 | 2014-08-28 |
| 1427465434 | Martha Read | Family Medicine | 2208 Danville Rd Sw Ste A, Decatur, AL 35601 | 2014-07-22 |
| 1205242948 | Pure Heart Home Care of Alabama, LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 107 B 14th Street Sw, Decatur, AL 35601 | 2014-07-02 |
| 1720492242 | Christopher John Phillips | Emergency Medicine | 1201 7th Street Se, Decatur, AL 35601 | 2014-06-12 |
| 1366794711 | Complete Dental Decatur LLC | Dentist | 1241 Point Mallard Parkway, Suite. 105, Decatur, AL 35601 | 2012-10-10 |
| Find all providers in zip 35601 | ||||
| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427686062 | Tara Cooley | Nurse Practitioner | 909 Tracey Ln, Decatur, AL 35601-7701 | 2020-03-30 |
| 1407489479 | Marathon Health LLC | Nurse Practitioner | 152 Ipsco St, Decatur, AL 35601-7412 | 2020-02-19 |
| 1518502475 | Marissa Lynne Henderson | Nurse Practitioner | 609 Medical Center Dr Ste 2700, Decatur, TX 76234-3839 | 2019-11-14 |
| 1912463456 | Kimberly S Williams | Nurse Practitioner | 4565 Riverwood Cir, Decatur, GA 30035-2935 | 2019-02-20 |
| 1164907242 | Megan Skelley | Nurse Practitioner | 487 Winn Way Ste 202, Decatur, GA 30030-1728 | 2018-09-25 |
| 1508359969 | Rebecca A Voyles | Nurse Practitioner | 575 W Hay St, Decatur, IL 62526-4164 | 2018-06-11 |
| 1598278558 | Vera Mahou | Nurse Practitioner | 4150 Snapfinger Woods Dr Ste 120, Decatur, GA 30035-3417 | 2017-11-13 |
| 1346753738 | Alexis Renee Graven | Nurse Practitioner | 2300 N Edward St Ste 2400, Decatur, IL 62526-4163 | 2017-11-08 |
| 1508240409 | Zachary Pitts | Nurse Practitioner | 2606 Woodridge Dr, Decatur, GA 30033-4835 | 2015-07-10 |
| 1891063095 | Alexis E. Daugherty | Nurse Practitioner | 603 Church St, Decatur, GA 30030-2517 | 2011-12-02 |
| Find all providers in DECATUR | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.