Healthcare Provider Details

I. General information

NPI: 1992631154
Provider Name (Legal Business Name): ANDWELLE FOSTER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4234 ILLINOIS AVE
FORT LEONARD WOOD MO
65473
US

IV. Provider business mailing address

100 EDNA APT A
WAYNESVILLE MO
65583-7932
US

V. Phone/Fax

Practice location:
  • Phone: 573-596-4073
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: