Provider Demographics
NPI:1245035104
Name:FORREST, EVANGELINE LAMANILAO (APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:EVANGELINE
Middle Name:LAMANILAO
Last Name:FORREST
Suffix:
Gender:
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:352 WORLEY ST
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72740-2003
Mailing Address - Country:US
Mailing Address - Phone:870-723-4172
Mailing Address - Fax:
Practice Address - Street 1:506 LITTLE CREEK CUT OFF RD
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:AR
Practice Address - Zip Code:72150-7798
Practice Address - Country:US
Practice Address - Phone:870-942-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-14
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR231743363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health