Provider Demographics
NPI:1902218308
Name:FORYS, HEATHER LYNN (APN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LYNN
Last Name:FORYS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:LYNN
Other - Last Name:BARNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1005 HEALTH CENTER DR STE 201
Mailing Address - Street 2:
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938-4653
Mailing Address - Country:US
Mailing Address - Phone:217-342-3400
Mailing Address - Fax:217-258-2216
Practice Address - Street 1:5 E CUMBERLAND RD
Practice Address - Street 2:
Practice Address - City:ALTAMONT
Practice Address - State:IL
Practice Address - Zip Code:62411-1271
Practice Address - Country:US
Practice Address - Phone:618-483-6151
Practice Address - Fax:618-483-6153
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-20
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209011417363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209011417OtherAPN LICENSE
IL209011417OtherAPN LICENSE