Individual
AUDREY FORTENBERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1728 S CARSON AVE, TULSA, OK 74119-4610
(918) 607-3932
Mailing address
1706 N SANTA FE AVE, TULSA, OK 74127-2530
(918) 527-8423
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200287120A
—
OK
Enumeration date
03/14/2013
Last updated
03/17/2018
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