Provider Demographics
NPI:1093773202
Name:FOSTER, DONNA S (CFNP)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:S
Last Name:FOSTER
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 W PEACE ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-4325
Mailing Address - Country:US
Mailing Address - Phone:601-691-5175
Mailing Address - Fax:601-691-5952
Practice Address - Street 1:259 W PEACE ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MS
Practice Address - Zip Code:39046-4325
Practice Address - Country:US
Practice Address - Phone:601-691-5175
Practice Address - Fax:601-691-5952
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR734369363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1401061742540OtherPECOS
MN640927953OtherTRICARE
MSR734369OtherSTATE LICENSE MS
MS00118868Medicaid
MS11346844OtherCAQH
MSR734369OtherSTATE LICENSE NUMBER
MN500021341OtherRAILROAD MEDICARE