Provider Demographics
NPI:1245696848
Name:FOSTER, KRISTIN R (NP-C)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:R
Last Name:FOSTER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 DUNCAN AVE
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120
Mailing Address - Country:US
Mailing Address - Phone:601-807-1143
Mailing Address - Fax:601-446-9834
Practice Address - Street 1:136 JEFF DAVIS BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120
Practice Address - Country:US
Practice Address - Phone:601-492-2224
Practice Address - Fax:601-492-2231
Is Sole Proprietor?:No
Enumeration Date:2016-01-12
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901387363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01753371Medicaid