Healthcare Provider Details

I. General information

NPI: 1609793421
Provider Name (Legal Business Name): JAKAYLA FORREST
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

934 VANDORA SPRINGS RD
GARNER NC
27529-3544
US

IV. Provider business mailing address

934 VANDORA SPRINGS RD
GARNER NC
27529-3544
US

V. Phone/Fax

Practice location:
  • Phone: 919-728-7170
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number5024789
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: