Individual
KRISTIN DAWN FORTIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
22080 HWY 20, VACHERIE, LA 70090
(985) 265-3061
Mailing address
424 HALE, THIBODAUX, LA 70301
(985) 859-8954
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
AP05988
LA
363LP2300X
Primary Care Nurse Practitioner
Primary
AP05988
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2119761
—
LA
01
—
3C865CS40
MEDICARE
LA
Enumeration date
03/22/2007
Last updated
03/08/2023
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