Provider Demographics
NPI:1558591677
Name:FOREST HEALTH CLINIC, PLLC
Entity Type:Organization
Organization Name:FOREST HEALTH CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WATCHARA
Authorized Official - Middle Name:
Authorized Official - Last Name:SILO
Authorized Official - Suffix:
Authorized Official - Credentials:MS, APRN, BC, FNP
Authorized Official - Phone:936-242-1627
Mailing Address - Street 1:8000 HIGHWAY 242
Mailing Address - Street 2:STE 116
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77385-4358
Mailing Address - Country:US
Mailing Address - Phone:936-242-1627
Mailing Address - Fax:936-242-1312
Practice Address - Street 1:8000 HIGHWAY 242
Practice Address - Street 2:STE 116
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77385-4358
Practice Address - Country:US
Practice Address - Phone:936-242-1627
Practice Address - Fax:936-242-1312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX599159363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0030SUOtherBCBS
0030SUOtherBCBS