Provider Demographics
NPI:1295409290
Name:FORREST, MEAGAN W (NP)
Entity Type:Individual
Prefix:
First Name:MEAGAN
Middle Name:W
Last Name:FORREST
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MEAGAN
Other - Middle Name:W
Other - Last Name:WOODALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1509 DULLES DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-3718
Mailing Address - Country:US
Mailing Address - Phone:337-408-0797
Mailing Address - Fax:337-943-0830
Practice Address - Street 1:2900 WESTFORK DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70827-0010
Practice Address - Country:US
Practice Address - Phone:337-991-9276
Practice Address - Fax:337-943-0846
Is Sole Proprietor?:No
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA221528363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily