Provider Demographics
NPI:1245403443
Name:FOSTER, PAULA SUE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:SUE
Last Name:FOSTER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:PAULA
Other - Middle Name:SUE
Other - Last Name:EMMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:822 N ANDOVER RD
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:KS
Mailing Address - Zip Code:67002-9527
Mailing Address - Country:US
Mailing Address - Phone:316-452-5113
Mailing Address - Fax:316-452-5171
Practice Address - Street 1:822 N ANDOVER RD
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:KS
Practice Address - Zip Code:67002-9527
Practice Address - Country:US
Practice Address - Phone:316-452-5113
Practice Address - Fax:316-452-5171
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-68540-072163WR0006X
KS78087363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201195640AMedicaid