Healthcare Provider Details

I. General information

NPI: 1326490087
Provider Name (Legal Business Name): SETH FORGEY PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2016
Last Update Date: 05/26/2020
Certification Date: 05/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 BURLINGTON RD
JACKSON OH
45640-9360
US

IV. Provider business mailing address

PO BOX 188
CHILLICOTHEE OH
45601-0188
US

V. Phone/Fax

Practice location:
  • Phone: 740-286-5075
  • Fax: 740-395-8411
Mailing address:
  • Phone: 740-734-3667
  • Fax: 740-775-7855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.019391
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: