Grace Jean Fornwalt, MHR, ATC, LAT, CES

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

987 Issued in OK

Practice address

375 Triad Village Dr Unit 14
Norman, OK 73071-2896

Phone

(314) 753-6506

NPI assigned

Apr 22, 2019

Last updated

Apr 22, 2019By the provider in NPPES

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1555891200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1555891200000",
    "number": "1518520931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "375 TRIAD VILLAGE DR UNIT 14",
            "city": "NORMAN",
            "state": "OK",
            "postal_code": "730712896",
            "telephone_number": "314-753-6506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "375 TRIAD VILLAGE DR UNIT 14",
            "city": "NORMAN",
            "state": "OK",
            "postal_code": "730712896",
            "telephone_number": "314-753-6506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORNWALT",
        "first_name": "GRACE",
        "middle_name": "JEAN",
        "credential": "MHR, ATC, LAT, CES",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-22",
        "last_updated": "2019-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MO",
            "license": "2015032686",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "TX",
            "license": null,
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "OK",
            "license": "987",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katelyn Fore
• Dashiell Hayes Foree
• Jah'Ni Anaya Foreman
• Rory Forinash, PHARMD
• Lucas Forman, RBT
• Forrest Shed,O.D., Inc
• Bonnie Shea Forster
• Kylie O'Shea Forster, LPC
• Kortney Forsyth, BS CMII, BHWC, CPRSS
• Braden Fortner, DPT

• Athletic Trainer in Norman, OK
• Providers in Norman, OK by specialty
• Athletic Trainer in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.