Healthcare Provider Details

I. General information

NPI: 1265731608
Provider Name (Legal Business Name): DR. BEVERLY J. FOSTER, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2011
Last Update Date: 03/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 W MARKHAM ST
LITTLE ROCK AR
72205-5926
US

IV. Provider business mailing address

PO BOX 2419
LITTLE ROCK AR
72203-2419
US

V. Phone/Fax

Practice location:
  • Phone: 501-371-0152
  • Fax: 501-371-0253
Mailing address:
  • Phone: 501-371-9994
  • Fax: 501-224-0784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number971
License Number StateAR

VIII. Authorized Official

Name: DR. BEVERLY JEAN FOSTER
Title or Position: PRESIDENT
Credential: D,C,
Phone: 501-371-0253