Provider Demographics
NPI:1114129731
Name:FORTNEY, KIMBERLY BENSON (AT,C)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:BENSON
Last Name:FORTNEY
Suffix:
Gender:F
Credentials:AT,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 DERBY PL
Mailing Address - Street 2:
Mailing Address - City:CHARLES TOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25414-3500
Mailing Address - Country:US
Mailing Address - Phone:304-728-6185
Mailing Address - Fax:
Practice Address - Street 1:3471 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:IJAMSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21754-9416
Practice Address - Country:US
Practice Address - Phone:240-236-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer