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General NPI Number Information
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NPI Number | 1700729076
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Entity Type | Organization
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Legal Business Name | FORAKER WELLNESS, PLLC
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Dates
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Enumeration Date | 04/13/2026
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Last Update Date | 04/13/2026
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Provider Practice Location Address
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Address Line | 309 S MAIN ST
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City | BREWER
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State | ME
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Zip | 04412-2231
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Country | US
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Telephone | 207-735-5851
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Fax |
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Provider Business Mailing Address
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Address Line | 1305 KENNEBEC RD
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City | HAMPDEN
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State | ME
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Zip | 04444-3110
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Country | US
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Telephone | 207-735-5851
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. JACLYN KIMBERLY FORAKER
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Credential | FNP-C
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Telephone | 207-735-5851
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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