MEDICARE: STEPHANIE LYNN FOSTER PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	07704	TX

General Provider Information

NPI Number	:	1700939618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE LYNN FOSTER PA-C

Provider Business Mailing Address
First Line	:	9622 WEBB CHAPEL RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75220-4940
Country	:	US
Telephone Number	:	214-358-3601
Fax Number	:	214-358-3639

Provider Business Practice Location Address
First Line	:	9622 WEBB CHAPEL RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75220-4940
Country	:	US
Telephone Number	:	214-358-3601
Fax Number	:	214-358-3639

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	02/25/2020

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