Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mrs. Christian R Fortenberry, FNP

Individual provider Family Nurse Practitioner · NPI 1003415266

Mrs. Christian R Fortenberry, FNP is a Nurse Practitioner in Jackson, Mississippi. Qualified in 2020, 6 years ago. Practices with St Dominic Medical Associates LLC, a 127-clinician group, works from 2 locations, accepts Medicare assignment and offers telehealth. Licensed in Mississippi.

Years since qualifying
6
Licensed in
MS
In the registry since
2020
What do these letters mean?
FNP — Family Nurse Practitioner
A nurse practitioner who treats patients of all ages, much like a family doctor.

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Practice location Address checks out

971 Lakeland Dr Ste 557
Jackson, MS 39216-4661
Phone: (601) 200-4560
Fax: (601) 200-4580
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 786 Lake Harbour Dr, Ridgeland, MS 39157-4303 — (601) 499-0022

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 904008 (MS)

Record details

NPI number1003415266
Entity typeIndividual (Type 1)
GenderFemale
Credentials FNP
Sole proprietorNo
NPI enumeratedOctober 20, 2020
Last updated in NPPESOctober 2, 2025
Certification dateOctober 2, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice St. Dominic Medical Associates Llc — 127 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations3 on file with Medicare

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