Provider Demographics
NPI:1821561739
Name:FORBES, TAHEERA (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:TAHEERA
Middle Name:
Last Name:FORBES
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1089
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70404-1089
Mailing Address - Country:US
Mailing Address - Phone:985-892-7070
Mailing Address - Fax:855-821-4499
Practice Address - Street 1:102 S MONROE ST STE B
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:LA
Practice Address - Zip Code:71055-3357
Practice Address - Country:US
Practice Address - Phone:318-232-6835
Practice Address - Fax:318-639-9245
Is Sole Proprietor?:No
Enumeration Date:2019-01-03
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA202037363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2508121Medicaid