Healthcare Provider Details

I. General information

NPI: 1922013580
Provider Name (Legal Business Name): CATHY D FORBES APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 09/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VETERANS WAY, BLD 160
MT HOME TN
37684
US

IV. Provider business mailing address

PO BOX 4000
MOUNTAIN HOME TN
37684-4000
US

V. Phone/Fax

Practice location:
  • Phone: 423-926-1171
  • Fax: 423-979-3685
Mailing address:
  • Phone: 423-926-1171
  • Fax: 423-979-3685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPN0000011996
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: