Provider Demographics
NPI:1184903585
Name:FORESTER, BRANDON K (APRN)
Entity type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:K
Last Name:FORESTER
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:MR
Other - First Name:BRANDON
Other - Middle Name:K
Other - Last Name:FORESTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSN, NP-C
Mailing Address - Street 1:22814 LAWRENCE 1170
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:MO
Mailing Address - Zip Code:65769-7213
Mailing Address - Country:US
Mailing Address - Phone:417-612-0552
Mailing Address - Fax:
Practice Address - Street 1:210 NE TUDOR RD
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-5696
Practice Address - Country:US
Practice Address - Phone:888-256-3814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-16
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011016061363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner