Healthcare Provider Details

I. General information

NPI: 1457515363
Provider Name (Legal Business Name): JESSICA LYN FOSTER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2008
Last Update Date: 05/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3805 CHEROKEE ST NW
KENNESAW GA
30144-2085
US

IV. Provider business mailing address

3805 CHEROKEE ST NW
KENNESAW GA
30144-2085
US

V. Phone/Fax

Practice location:
  • Phone: 770-426-5666
  • Fax: 770-426-9212
Mailing address:
  • Phone: 770-426-5666
  • Fax: 770-426-9212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN 159786 NP
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: