Provider Demographics
NPI:1104675529
Name:FORKOM, NAHVOTE KAREN (PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:NAHVOTE
Middle Name:KAREN
Last Name:FORKOM
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:NAHVOTE
Other - Middle Name:KAREN
Other - Last Name:FORKOM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NO OTHER NAME
Mailing Address - Street 1:1005 DAGEN LN
Mailing Address - Street 2:
Mailing Address - City:JUNCTION CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66441-2091
Mailing Address - Country:US
Mailing Address - Phone:804-503-0544
Mailing Address - Fax:
Practice Address - Street 1:1133 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-2770
Practice Address - Country:US
Practice Address - Phone:804-503-0544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-17
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2024006595363LP0808X
KS53-83408-102363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health