Healthcare Provider Details

I. General information

NPI: 1871481390
Provider Name (Legal Business Name): KEANDRA VIOLETA FORTE CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2025
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2916
US

IV. Provider business mailing address

525 LEFTWICH LN # 78
ANNAPOLIS MD
21401-8818
US

V. Phone/Fax

Practice location:
  • Phone: 888-884-2327
  • Fax:
Mailing address:
  • Phone: 703-953-5473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberNP221201968
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: