Healthcare Provider Details

I. General information

NPI: 1821561739
Provider Name (Legal Business Name): TAHEERA FORBES FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2019
Last Update Date: 02/07/2022
Certification Date: 02/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 S MONROE ST STE B
MINDEN LA
71055-3357
US

IV. Provider business mailing address

PO BOX 1089
HAMMOND LA
70404-1089
US

V. Phone/Fax

Practice location:
  • Phone: 318-232-6835
  • Fax: 318-639-9245
Mailing address:
  • Phone: 985-892-7070
  • Fax: 855-821-4499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number202037
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: