Provider Demographics
NPI:1750013314
Name:FORTNEY, DUSTIN D (ACNP-C)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:D
Last Name:FORTNEY
Suffix:
Gender:M
Credentials:ACNP-C
Other - Prefix:
Other - First Name:DUSTIN
Other - Middle Name:D
Other - Last Name:FORTNEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN-ACNP
Mailing Address - Street 1:303 THORNBERRY LN
Mailing Address - Street 2:
Mailing Address - City:ELLAMORE
Mailing Address - State:WV
Mailing Address - Zip Code:26267-2600
Mailing Address - Country:US
Mailing Address - Phone:304-614-5071
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26506-1200
Practice Address - Country:US
Practice Address - Phone:304-598-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV113699363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care