Provider Demographics
NPI:1003199100
Name:FOSTER, MALOTSHA ANNA (NP)
Entity Type:Individual
Prefix:
First Name:MALOTSHA
Middle Name:ANNA
Last Name:FOSTER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3506 BARBED WIRE DR
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-2402
Mailing Address - Country:US
Mailing Address - Phone:254-289-5123
Mailing Address - Fax:
Practice Address - Street 1:740 S AMY LN
Practice Address - Street 2:STE 101
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-1343
Practice Address - Country:US
Practice Address - Phone:254-699-8521
Practice Address - Fax:254-699-8528
Is Sole Proprietor?:No
Enumeration Date:2011-09-25
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX739736363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily