Provider Demographics
NPI:1568123180
Name:FORTHMAN, CASEY L (APRN)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:L
Last Name:FORTHMAN
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 MEDICAL CENTER DR STE 201A
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-7907
Mailing Address - Country:US
Mailing Address - Phone:270-442-6161
Mailing Address - Fax:
Practice Address - Street 1:225 MEDICAL CENTER DR STE 201A
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-7907
Practice Address - Country:US
Practice Address - Phone:270-442-6161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-05
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3015977363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily