Provider Demographics
NPI:1528086832
Name:FOSTER, BETHEL C (CFNP)
Entity type:Individual
Prefix:
First Name:BETHEL
Middle Name:C
Last Name:FOSTER
Suffix:
Gender:F
Credentials:CFNP
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 6227
Mailing Address - Street 2:
Mailing Address - City:PEARL
Mailing Address - State:MS
Mailing Address - Zip Code:39288-6227
Mailing Address - Country:US
Mailing Address - Phone:601-825-7280
Mailing Address - Fax:601-825-8130
Practice Address - Street 1:202 JEFFERSON STREET
Practice Address - Street 2:
Practice Address - City:NEW HEBRON
Practice Address - State:MS
Practice Address - Zip Code:39140
Practice Address - Country:US
Practice Address - Phone:601-694-2116
Practice Address - Fax:601-694-2119
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR560227363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03709295Medicaid
MSP96248Medicare UPIN