Provider Demographics
NPI:1407611908
Name:JNK MEDICAL TRANSPORT
Entity type:Organization
Organization Name:JNK MEDICAL TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CALISHA
Authorized Official - Middle Name:T
Authorized Official - Last Name:FORTNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-512-9452
Mailing Address - Street 1:463 LONG ACRE DR
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-8229
Mailing Address - Country:US
Mailing Address - Phone:318-512-9452
Mailing Address - Fax:
Practice Address - Street 1:463 LONG ACRE DR
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-8229
Practice Address - Country:US
Practice Address - Phone:318-379-4244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-14
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)