Provider Demographics
NPI:1588974364
Name:FORTHNER, LAKENYA (FNP-BC)
Entity type:Individual
Prefix:
First Name:LAKENYA
Middle Name:
Last Name:FORTHNER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4660 BEECHNUT ST
Mailing Address - Street 2:STE 218
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-1825
Mailing Address - Country:US
Mailing Address - Phone:713-521-0006
Mailing Address - Fax:
Practice Address - Street 1:4660 BEECHNUT ST STE 218
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77096-1825
Practice Address - Country:US
Practice Address - Phone:713-521-0006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-14
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX790602363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX281106901Medicaid
TX848N17OtherBLUE CROSS BLUE SHIELD OF TEXAS
TXTXB128183Medicare PIN
TXP00948640Medicare PIN