Healthcare Provider Details

I. General information

NPI: 1174591085
Provider Name (Legal Business Name): BRANDON M FOSTER ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRANDON BRIGHT ACNP

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 11/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 MEDICAL PARK DR SUITE 410
COLUMBIA SC
29203-8005
US

IV. Provider business mailing address

2 MEDICAL PARK RD SUITE 502
COLUMBIA SC
29203-6808
US

V. Phone/Fax

Practice location:
  • Phone: 803-540-1000
  • Fax: 803-540-1050
Mailing address:
  • Phone: 803-540-1000
  • Fax: 803-540-1050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPN1147
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: