Provider Demographics
NPI:1497814289
Name:FOSTER, DENISE L (PA)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:L
Last Name:FOSTER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 HIGHWAY 161
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:MO
Mailing Address - Zip Code:63334-2431
Mailing Address - Country:US
Mailing Address - Phone:573-324-3333
Mailing Address - Fax:573-324-3334
Practice Address - Street 1:905 HIGHWAY 161
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:MO
Practice Address - Zip Code:63334-2431
Practice Address - Country:US
Practice Address - Phone:573-324-3333
Practice Address - Fax:573-324-3334
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001032146363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical