Provider Demographics
NPI:1275861940
Name:FOSTER, MICHELLE ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANN
Last Name:FOSTER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 E RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78741-3083
Mailing Address - Country:US
Mailing Address - Phone:512-448-3778
Mailing Address - Fax:
Practice Address - Street 1:2410 E RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78741-3083
Practice Address - Country:US
Practice Address - Phone:512-448-3778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-18
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05929363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant