Provider Demographics
NPI:1174591085
Name:FOSTER, BRANDON M (ACNP)
Entity type:Individual
Prefix:MRS
First Name:BRANDON
Middle Name:M
Last Name:FOSTER
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:MRS
Other - First Name:BRANDON
Other - Middle Name:
Other - Last Name:BRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACNP
Mailing Address - Street 1:2 MEDICAL PARK RD
Mailing Address - Street 2:SUITE 502
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-6808
Mailing Address - Country:US
Mailing Address - Phone:803-540-1000
Mailing Address - Fax:803-540-1050
Practice Address - Street 1:8 MEDICAL PARK DR
Practice Address - Street 2:SUITE 410
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-8005
Practice Address - Country:US
Practice Address - Phone:803-540-1000
Practice Address - Fax:803-540-1050
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN1147363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP0580Medicaid
SCNP0580Medicaid
P53072Medicare UPIN
SCP530722603Medicare PIN