Individual
JAMIE VICE FORTNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1203 MEDICAL PARK DR, OXFORD, MS 38655-5327
(662) 513-4399
(662) 513-4330
Mailing address
1203 MEDICAL PARK DR, OXFORD, MS 38655-5327
(662) 513-4399
(662) 513-4330
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
F0613716
MS
363LF0000X
Family Nurse Practitioner
Primary
R878817
MS
Other
Enumeration date
08/27/2013
Last updated
08/28/2014
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