Provider Demographics
NPI:1447734165
Name:FORREST, DENAI LYNN (DNP APRN-CNP PMHNP)
Entity Type:Individual
Prefix:
First Name:DENAI
Middle Name:LYNN
Last Name:FORREST
Suffix:
Gender:F
Credentials:DNP APRN-CNP PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 SILVA RD
Mailing Address - Street 2:
Mailing Address - City:BELEN
Mailing Address - State:NM
Mailing Address - Zip Code:87002-7563
Mailing Address - Country:US
Mailing Address - Phone:505-314-4966
Mailing Address - Fax:
Practice Address - Street 1:19478 HIGHWAY 314
Practice Address - Street 2:
Practice Address - City:BELEN
Practice Address - State:NM
Practice Address - Zip Code:87002-8223
Practice Address - Country:US
Practice Address - Phone:505-357-4385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-19
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM53911363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health