Healthcare Provider Details

I. General information

NPI: 1659078418
Provider Name (Legal Business Name): FOSTER FIRST ASSIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2023
Last Update Date: 02/13/2023
Certification Date: 02/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 OLD MONROE MADISON HWY
MONROE GA
30655-7655
US

IV. Provider business mailing address

3905 MELCER DR STE 601
ROWLETT TX
75088-4033
US

V. Phone/Fax

Practice location:
  • Phone: 214-227-2457
  • Fax: 214-764-0880
Mailing address:
  • Phone: 214-227-2457
  • Fax: 214-764-0880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number
License Number State

VIII. Authorized Official

Name: CASEY A FOSTER
Title or Position: OWNER
Credential: RNFA
Phone: 214-227-2457