Healthcare Provider Details

I. General information

NPI: 1255793402
Provider Name (Legal Business Name): JENNIFER FOSTER FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2016
Last Update Date: 03/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2013 JEFFERSON ST SW FL 2
ROANOKE VA
24014-2419
US

IV. Provider business mailing address

2013 JEFFERSON ST SW FL 2
ROANOKE VA
24014-2419
US

V. Phone/Fax

Practice location:
  • Phone: 540-982-0237
  • Fax: 540-982-2719
Mailing address:
  • Phone: 540-982-0237
  • Fax: 540-982-2719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024173498
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: