Provider Demographics
NPI:1780278531
Name:FORREST, KIARA
Entity type:Individual
Prefix:
First Name:KIARA
Middle Name:
Last Name:FORREST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3008 30TH STREET
Mailing Address - Street 2:APT. A
Mailing Address - City:NITRO
Mailing Address - State:WV
Mailing Address - Zip Code:25143
Mailing Address - Country:US
Mailing Address - Phone:937-219-8569
Mailing Address - Fax:
Practice Address - Street 1:3008 30TH STREET
Practice Address - Street 2:APT. A
Practice Address - City:NITRO
Practice Address - State:WV
Practice Address - Zip Code:25143
Practice Address - Country:US
Practice Address - Phone:937-219-8569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant