Healthcare Provider Details

I. General information

NPI: 1902218308
Provider Name (Legal Business Name): HEATHER LYNN FORYS APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HEATHER LYNN BARNES

II. Dates (important events)

Enumeration Date: 05/20/2014
Last Update Date: 04/06/2023
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 E CUMBERLAND RD
ALTAMONT IL
62411-1271
US

IV. Provider business mailing address

1005 HEALTH CENTER DR STE 201
MATTOON IL
61938-4653
US

V. Phone/Fax

Practice location:
  • Phone: 618-483-6151
  • Fax: 618-483-6153
Mailing address:
  • Phone: 217-342-3400
  • Fax: 217-258-2216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209011417
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: