Provider Demographics
NPI:1710577671
Name:FORBES, ANDREW (RN, MED)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:
Last Name:FORBES
Suffix:
Gender:M
Credentials:RN, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 POPLAR BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-2111
Mailing Address - Country:US
Mailing Address - Phone:601-454-1914
Mailing Address - Fax:
Practice Address - Street 1:1314 POPLAR BLVD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-2111
Practice Address - Country:US
Practice Address - Phone:601-454-1914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-24
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS876049163WG0000X, 163WP0200X, 163WP0218X, 163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
No163WP0218XNursing Service ProvidersRegistered NursePediatric Oncology