Provider Demographics
NPI:1326100942
Name:FORTNER, ADRIA JUNE (MS)
Entity Type:Individual
Prefix:MRS
First Name:ADRIA
Middle Name:JUNE
Last Name:FORTNER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-1909
Mailing Address - Country:US
Mailing Address - Phone:270-564-0237
Mailing Address - Fax:270-761-5394
Practice Address - Street 1:311 N 10TH ST
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-1909
Practice Address - Country:US
Practice Address - Phone:270-564-0237
Practice Address - Fax:270-761-5394
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist