Healthcare Provider Details

I. General information

NPI: 1063759744
Provider Name (Legal Business Name): REBECCA ARTHUR FOSTER P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2013
Last Update Date: 01/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1154 LOGAN SEWELL DR
VIDALIA LA
71373-3342
US

IV. Provider business mailing address

1154 LOGAN SEWELL DR
VIDALIA LA
71373-3342
US

V. Phone/Fax

Practice location:
  • Phone: 318-336-8166
  • Fax: 318-336-8169
Mailing address:
  • Phone: 318-336-8166
  • Fax: 318-336-8169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA.200501
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: