Provider Demographics
NPI:1174911358
Name:FORTE, RAKEISHA NICHOLE (NP-C)
Entity type:Individual
Prefix:MS
First Name:RAKEISHA
Middle Name:NICHOLE
Last Name:FORTE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:RAKEISHA
Other - Middle Name:NICHOLE
Other - Last Name:FORTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP-C
Mailing Address - Street 1:5000 CREEKSIDE LN
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-3293
Mailing Address - Country:US
Mailing Address - Phone:910-578-9160
Mailing Address - Fax:
Practice Address - Street 1:3720 DAVINCI CT
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-7627
Practice Address - Country:US
Practice Address - Phone:770-417-2018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-23
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN214740363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily