NPI Details
Courtney Nicolle Forman, PMHNP-BC, FNP-C, FPA is a nurse practitioner in Rockford, IL with 14 years of experience. The provider is (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. Courtney Nicolle Forman, PMHNP-BC, FNP-C, FPA NPI is 1376099127. The provider is registered as an individual entity type.
The NPPES NPI record indicates the provider is a female.
Education
Medical School: INDIANA UNIVERSITY SCHOOL OF MEDICINE
Graduation Year:2011
The provider's business location address is:
2823 GLENWOOD AVE
ROCKFORD, IL
ZIP 61101
Phone: (815) 968-5342
Fax: (815) 968-4656
The NPI 1376099127 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.
The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.
- Follow-up nursing facility visit per day, typically 15 minutes (HCPCS:99308)
- Follow-up nursing facility visit per day, typically 25 minutes (HCPCS:99309)
- Established patient office or other outpatient visit, 30-39 minutes (HCPCS:99214)
- Established patient custodial care facility, group care, or assisted living visit, typically 40 minutes (HCPCS:99336)
- Follow-up nursing facility visit per day, typically 10 minutes (HCPCS:99307)
- Follow-up nursing facility visit per day, typically 35 minutes (HCPCS:99310)
- Established patient custodial care facility, group care, or assisted living visit, typically 25 minutes (HCPCS:99335)
The enumeration date for this NPI number is 8/31/2016 and was last updated on 4/15/2025.
Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 363L00000X | Nurse Practitioner | | 227.004073 | ILLINOIS | Yes |
| 2 | 363LF0000X | Nurse Practitioner | Family | 209014910 | ILLINOIS | No |
