Provider Demographics
NPI:1548446289
Name:FOREST, YVONNE L (LMT)
Entity type:Individual
Prefix:MRS
First Name:YVONNE
Middle Name:L
Last Name:FOREST
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1121
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42302-1121
Mailing Address - Country:US
Mailing Address - Phone:270-316-4565
Mailing Address - Fax:
Practice Address - Street 1:1517 E 18TH ST
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1088
Practice Address - Country:US
Practice Address - Phone:270-316-4565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-2015174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist