Healthcare Provider Details

I. General information

NPI: 1710577671
Provider Name (Legal Business Name): ANDREW FORBES RN, MED
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2021
Last Update Date: 02/01/2021
Certification Date: 02/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 POPLAR BLVD
JACKSON MS
39202-2111
US

IV. Provider business mailing address

1314 POPLAR BLVD
JACKSON MS
39202-2111
US

V. Phone/Fax

Practice location:
  • Phone: 601-454-1914
  • Fax:
Mailing address:
  • Phone: 601-454-1914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number876049
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number876049
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code163WP0218X
TaxonomyPediatric Oncology Registered Nurse
License Number876049
License Number StateMS
# 4
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number876049
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: