Individual
JENNIFER D. FORTHMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
105 W E ST, TEHACHAPI, CA 93561-1607
(661) 823-7070
Mailing address
105 W E ST, PO BOX 1900, TEHACHAPI, CA 93561-1607
(661) 823-7070
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1523
OK
363AM0700X
Medical Physician Assistant
Primary
22143
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200075940A
—
OK
Enumeration date
04/28/2006
Last updated
10/04/2012
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