Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Courtney Nicolle Forman, PMHNP-BC, FNP-C, FPA

Individual provider Psychiatric/Mental Health Nurse Practitioner · NPI 1376099127

Courtney Nicolle Forman, PMHNP-BC, FNP-C, FPA is a Nurse Practitioner in Rockford, Illinois. Graduated from Indiana University School of Medicine in 2011, 15 years ago. Practices with Thrive Mental Wellness, PLLC, a 3-clinician group, works from 2 locations, accepts Medicare assignment and offers telehealth. Licensed in Illinois.

Years since qualifying
15
Trained at
Indiana University School of Medicine
Licensed in
IL
In the registry since
2016
Specialties on file
3
What do these letters mean?
PMHNP-BC — Psychiatric-Mental Health Nurse Practitioner, Board Certified
A board-certified psychiatric nurse practitioner.
FNP-C — Family Nurse Practitioner, Certified
A family nurse practitioner certified by the AANP.

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Practice location Address checks out

2823 Glenwood Ave
Rockford, IL 61101
Phone: (815) 968-5342
Fax: (815) 968-4656
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 13508 Julie Dr, Poplar Grove, IL 61065-7829 — (815) 209-8486

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X · Licence 227.004073 (IL)
Psychiatric/Mental Health Nurse Practitioner Taxonomy 363LP0808X · Licence 277004073 (IL)
Family Nurse Practitioner Taxonomy 363LF0000X · Licence 209014910 (IL)

Record details

NPI number1376099127
Entity typeIndividual (Type 1)
GenderFemale
Credentials PMHNP-BC , FNP-C , FPA
Sole proprietorNo
NPI enumeratedAugust 31, 2016
Last updated in NPPESMarch 30, 2026
Certification dateMarch 30, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolINDIANA UNIVERSITY SCHOOL OF MEDICINE
Graduated 2011 (15 years in practice)
Group practice Thrive Mental Wellness, Pllc — 3 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations2 on file with Medicare

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