Provider Demographics
NPI:1063288454
Name:FORREST, KASHAREL
Entity type:Individual
Prefix:MS
First Name:KASHAREL
Middle Name:
Last Name:FORREST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1504 CALLAWAY LOOP
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-3670
Mailing Address - Country:US
Mailing Address - Phone:574-300-1282
Mailing Address - Fax:
Practice Address - Street 1:1504 CALLAWAY LOOP
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3670
Practice Address - Country:US
Practice Address - Phone:574-300-1282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-28
Last Update Date:2023-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No172A00000XOther Service ProvidersDriver
No172V00000XOther Service ProvidersCommunity Health Worker