Healthcare Provider Details

I. General information

NPI: 1225754591
Provider Name (Legal Business Name): EMERALD LYNN FOUST PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2022
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16954 CONNEAUT LAKE RD
MEADVILLE PA
16335-3738
US

IV. Provider business mailing address

16954 CONNEAUT LAKE RD
MEADVILLE PA
16335-3738
US

V. Phone/Fax

Practice location:
  • Phone: 814-200-9904
  • Fax: 814-540-4026
Mailing address:
  • Phone: 814-200-9904
  • Fax: 814-540-4026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberOA006288
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: