MEDICARE: FORREST AND ASSOCIATES PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1205480126
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORREST AND ASSOCIATES PLLC

Provider Business Mailing Address
First Line	:	140 IOWA AVE STE 210
Second Line	:
City	:	BELLEVILLE
State	:	IL
Zip	:	62220-3940
Country	:	US
Telephone Number	:	618-641-9142
Fax Number	:	618-641-9144

Provider Business Practice Location Address
First Line	:	140 IOWA AVE STE 210
Second Line	:
City	:	BELLEVILLE
State	:	IL
Zip	:	62220-3940
Country	:	US
Telephone Number	:	618-641-9142
Fax Number	:	618-641-9144

Authorized Official
Title or Position	:	APRN/OWNER
Name	:	MRS. ARIKA E FORREST
Credential	:	APRN
Telephone Number	:	618-641-9142

Provider Enumeration Date	:	07/29/2019
Last Update Date	:	07/29/2019

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