Individual
JESSICA FORTMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
9075 CENTRE POINTE DR STE 200, WEST CHESTER, OH 45069
(513) 221-1100
(513) 569-5312
Mailing address
PO BOX 643398, CINCINNATI, OH 45264-3398
(513) 221-1100
(513) 569-5297
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50.003826RX
OH
363AS0400X
Surgical Physician Assistant
50.003826RX
OH
Other
Enumeration date
09/04/2013
Last updated
05/17/2018
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