Individual
CLARA SUE FORRESTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
4405 RIVER OAKS BLVD, FORT WORTH, TX 76114-2326
(817) 624-1770
(817) 625-1287
Mailing address
PO BOX 99371, FORT WORTH, TX 76199-0371
(682) 885-1855
(682) 885-7347
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
531980
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00U87Z
MEDICARE PIN GROUP
TX
05
—
062616004
—
TX
01
—
062616005
CSHCN
TX
01
—
137345810
CSHCN GROUP
TX
01
—
140442852
MEDICAID GROUP
TX
Enumeration date
01/09/2006
Last updated
04/04/2012
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