Healthcare Provider Details

I. General information

NPI: 1265480313
Provider Name (Legal Business Name): VASHTI JUDE FORBES FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VASTHI JUDE FORBES FNP-C

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 02/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HIGHWAY 69 NORTH AND FM 2971
RUSK TX
75785
US

IV. Provider business mailing address

PO BOX 140753
AUSTIN TX
78714-0753
US

V. Phone/Fax

Practice location:
  • Phone: 512-680-5142
  • Fax:
Mailing address:
  • Phone: 512-680-5142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number547348
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: