Phedra L Forist, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

4703094449 Issued in MI

Practice address

3075 Orchard Vista Dr SE
Grand Rapids, MI 49546-7069

Phone

(616) 262-2074

NPI assigned

Jul 28, 2020

Last updated

Jul 30, 2020By 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 2

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": "1595894400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596067200000",
    "number": "1871102640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3075 ORCHARD VISTA DR SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495467069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3075 ORCHARD VISTA DR SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495467069",
            "telephone_number": "616-262-2074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORIST",
        "first_name": "PHEDRA",
        "middle_name": "L",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-28",
        "last_updated": "2020-07-30",
        "certification_date": "2020-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "MI",
            "license": "4703094449",
            "primary": true
        },
        {
            "code": "164X00000X",
            "taxonomy_group": "",
            "desc": "Licensed Vocational Nurse",
            "state": "MI",
            "license": "4703094449",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Kip Michael Forness, PSYD
• Camryn Fornwalt

• Licensed Practical Nurse in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Licensed Practical Nurse in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2020; 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.