Healthcare Provider Details

I. General information

NPI: 1578213930
Provider Name (Legal Business Name): MEGAN KATHLEEN FORBES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN KATHLEEN SULLIVAN

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 HOSPITAL DR STE B
UKIAH CA
95482-4556
US

IV. Provider business mailing address

242 HOSPITAL DR STE B
UKIAH CA
95482-4556
US

V. Phone/Fax

Practice location:
  • Phone: 707-380-1075
  • Fax:
Mailing address:
  • Phone: 707-380-1075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA200467
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: