Provider Demographics
NPI:1366250748
Name:FORTENBERRY, LENA K (NP)
Entity type:Individual
Prefix:
First Name:LENA
Middle Name:K
Last Name:FORTENBERRY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 MELISSA LN
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-5911
Mailing Address - Country:US
Mailing Address - Phone:540-309-5936
Mailing Address - Fax:
Practice Address - Street 1:1088 LONDON LINKS DR
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551-4662
Practice Address - Country:US
Practice Address - Phone:434-534-6868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024188717363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily