Provider Demographics
NPI:1164259891
Name:FOSTER, JESSICA BROOK (MSN, APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:BROOK
Last Name:FOSTER
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 522
Mailing Address - Street 2:
Mailing Address - City:KEOTA
Mailing Address - State:OK
Mailing Address - Zip Code:74941-0522
Mailing Address - Country:US
Mailing Address - Phone:918-817-9954
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 522
Practice Address - Street 2:
Practice Address - City:KEOTA
Practice Address - State:OK
Practice Address - Zip Code:74941-0522
Practice Address - Country:US
Practice Address - Phone:918-817-9954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-17
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK219964363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily