Healthcare Provider Details

I. General information

NPI: 1275942369
Provider Name (Legal Business Name): ROBERT FOSTER NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2014
Last Update Date: 08/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 S MADISON ST
TUPELO MS
38801-4905
US

IV. Provider business mailing address

450 E PRESIDENT AVE
TUPELO MS
38801-5599
US

V. Phone/Fax

Practice location:
  • Phone: 662-377-5930
  • Fax: 662-377-5085
Mailing address:
  • Phone: 662-377-4685
  • Fax: 662-377-2755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR879580
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: