Courtney Nicolle Forman, PMHNP-BC, FNP-C, FPA

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

227.004073 Issued in IL

Practice address

2823 Glenwood Ave
Rockford, IL 61101

Phone

(815) 968-5342

Fax

(815) 968-4656

NPI assigned

Aug 31, 2016

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Indiana University School of Medicine, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Thrive Mental Wellness, PLLCGroup PAC ID 2860991627, 3 clinicians

Glenwood Center, LTDGroup PAC ID 2567552441, 2 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

58.33 of 100Reported as group

Quality

41.25

Promoting interoperability

0

Improvement activities

40

Cost

69.86

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Thrive Mental Wellness, PLLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Poplar Grove, IL
  • NPI 1447047469
  Medicare reassignment Care Compare group NPD Authorized official
• Glenwood Center LTD

  • Psychiatry Physician
  • Rockford, IL
  • NPI 1003033861
  Medicare reassignment Care Compare group

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1472601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774828800000",
    "number": "1376099127",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7080 MILL RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611082623",
            "telephone_number": "815-209-8486"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2823 GLENWOOD AVE",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "61101",
            "telephone_number": "815-968-5342",
            "fax_number": "815-968-4656"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13508 Julie Dr",
            "address_purpose": "LOCATION",
            "city": "Poplar Grove",
            "state": "IL",
            "postal_code": "610657829",
            "country_code": "US",
            "telephone_number": "815-209-8486",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FORMAN",
        "first_name": "COURTNEY",
        "middle_name": "NICOLLE",
        "credential": "PMHNP-BC, FNP-C, FPA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-31",
        "last_updated": "2026-03-30",
        "certification_date": "2026-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IL",
            "license": "277004073",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209014910",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "227.004073",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Forest City Diagnostic Imaging LLC
• Forest City Physical Therapy Limited Partnership
• Forest City Rehab and Nursing Center, LLC
• Forest View Counseling Services PLLC
• Form Orthotics & Prosthetics, PLLC
• Glen Forneris
• Brian Udell Foss, PTA
• Brian J. Foster, M.D.
• Gary Lee Foster, DDS
• Sadie Foster, MA

• Nurse Practitioner in Rockford, IL
• Providers in Rockford, IL by specialty
• Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.