Provider Demographics
NPI:1891876025
Name:FORTE, SONYA C (PA-C)
Entity Type:Individual
Prefix:
First Name:SONYA
Middle Name:C
Last Name:FORTE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SONYA
Other - Middle Name:C
Other - Last Name:TOON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3175 LITTLE BEAR HWY
Mailing Address - Street 2:
Mailing Address - City:GILBERTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42044-9208
Mailing Address - Country:US
Mailing Address - Phone:270-564-5988
Mailing Address - Fax:
Practice Address - Street 1:205 E ADAIR ST
Practice Address - Street 2:
Practice Address - City:SMITHLAND
Practice Address - State:KY
Practice Address - Zip Code:42081-9164
Practice Address - Country:US
Practice Address - Phone:270-928-2146
Practice Address - Fax:270-928-4492
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA540363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000317162OtherBLUE CROSS & BLUE SHIELD
11480494OtherCAQH
KY7100046630Medicaid
P00072624Medicare PIN
KY7100046630Medicaid
4929Medicare PIN
11480494OtherCAQH
1492907Medicare PIN
000000317162OtherBLUE CROSS & BLUE SHIELD
KY3322170Medicare PIN
KYK109341Medicare PIN