Healthcare Provider Details

I. General information

NPI: 1144188673
Provider Name (Legal Business Name): TABLEROCK HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 GRETNA RD UNIT 110
BRANSON MO
65616-7461
US

IV. Provider business mailing address

3200 GRETNA RD UNIT 110
BRANSON MO
65616-7461
US

V. Phone/Fax

Practice location:
  • Phone: 417-317-1908
  • Fax:
Mailing address:
  • Phone: 417-317-1908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. RYAN DEREK FORREST
Title or Position: CO-OWNER
Credential: FNP-BC
Phone: 417-559-6679