Healthcare Provider Details

I. General information

NPI: 1962485060
Provider Name (Legal Business Name): KASEY SWAFFORD-FORREST PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 HERNDON AVE STE. 101
CLOVIS CA
93611-6101
US

IV. Provider business mailing address

601 S 8TH ST
GRIFFIN GA
30224-4213
US

V. Phone/Fax

Practice location:
  • Phone: 559-797-4315
  • Fax: 559-797-1651
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number559416
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA18002
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number11429
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: