Provider Demographics
NPI:1861794471
Name:FOSTER, JACQUELIN L (APRN/FNP)
Entity type:Individual
Prefix:
First Name:JACQUELIN
Middle Name:L
Last Name:FOSTER
Suffix:
Gender:F
Credentials:APRN/FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 S WINGFIELD RD
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-3431
Mailing Address - Country:US
Mailing Address - Phone:309-212-1768
Mailing Address - Fax:
Practice Address - Street 1:920 MILLIKEN RD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-4906
Practice Address - Country:US
Practice Address - Phone:309-212-1768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-02
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4343363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily