Provider Demographics
NPI:1700254117
Name:FORSYTH, KATIE MARIE (MSN, NP-C)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:MARIE
Last Name:FORSYTH
Suffix:
Gender:F
Credentials:MSN, NP-C
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:MARIE
Other - Last Name:BRENNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, NP-C
Mailing Address - Street 1:28140 BOBWHITE CIR UNIT 56
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91350-4427
Mailing Address - Country:US
Mailing Address - Phone:424-237-4527
Mailing Address - Fax:
Practice Address - Street 1:19353 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91335-6302
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-02
Last Update Date:2017-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95000722363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily