Healthcare Provider Details

I. General information

NPI: 1669388674
Provider Name (Legal Business Name): KELSEY FOUST PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2485 SPRING GROVE DR APT 104
WINSTON SALEM NC
27103-7066
US

IV. Provider business mailing address

2485 SPRING GROVE DR APT 104
WINSTON SALEM NC
27103-7066
US

V. Phone/Fax

Practice location:
  • Phone: 336-671-8352
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: