Active NPI
Karen Lynn Forman, FNP-C
- Family Nurse Practitioner
- Tomah, WI
National Provider Identifier
1669843272
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 6587-33
- Practice address
- 500 E Veterans St
Tomah, WI 54660-3105 - Phone
- (608) 372-3971
- NPI assigned
- Oct 8, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 6587-33 | WI | Primary |
Addresses
Primary practice location
500 E Veterans St
Tomah, WI 54660-3105
Mailing address
500 E Veterans St
Tomah, WI 54660-3105
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1444262400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1728950400000",
"number": "1669843272",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 E VETERANS ST",
"city": "TOMAH",
"state": "WI",
"postal_code": "546603105"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 E VETERANS ST",
"city": "TOMAH",
"state": "WI",
"postal_code": "546603105",
"telephone_number": "608-372-3971"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FORMAN",
"first_name": "KAREN",
"middle_name": "LYNN",
"name_prefix": "Mrs.",
"credential": "FNP-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-10-08",
"last_updated": "2024-10-15",
"certification_date": "2024-10-15",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "WI",
"license": "6587-33",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tomah, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2024; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.