Provider Demographics
NPI:1073854576
Name:FORTNEY, JOSHUA THOMAS (RN, PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:THOMAS
Last Name:FORTNEY
Suffix:
Gender:M
Credentials:RN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 COMMONWEALTH AVE
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-2208
Mailing Address - Country:US
Mailing Address - Phone:810-288-2541
Mailing Address - Fax:
Practice Address - Street 1:1110 ELDON BAKER DR
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-1923
Practice Address - Country:US
Practice Address - Phone:810-235-3288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-07
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704294591163W00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse