Individual
MEGAN MARIE FORTMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
7991 BEECHMONT AVE STE C, CINCINNATI, OH 45255-3191
(513) 401-5979
(833) 972-4769
Mailing address
467 GREENSBORO DR, CENTERVILLE, OH 45459-2943
(937) 710-3171
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50.009305RX
OH
363A00000X
Physician Assistant
PA3672
KY
363A00000X
Physician Assistant
TC045
KY
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0125548
—
OH
05
—
300112389
—
IN
05
—
7101062000
—
KY
Enumeration date
01/25/2025
Last updated
03/27/2026
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