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1609152776
MISTY KAY WILDE FORTNER
LUBBOCK, TX
NPI
1609152776
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363A00000X Physician Assistant
(Licence: TX PA07530)
Enumeration Date
2011-11-02
Last Update Date
2021-08-11
Business Address
MISTY KAY WILDE FORTNER PA-C
5424 19TH ST STE 300
LUBBOCK, TX 79407-2164
Phone number: 806-795-4391
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Mailing Address
MISTY KAY WILDE FORTNER PA-C
5000 BRIARWOOD AVE
MIDLAND, TX 79707-2753
Phone number: 432-682-5385
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