Provider Demographics
NPI:1568979136
Name:FOSTER, ALISA ANN
Entity Type:Individual
Prefix:MS
First Name:ALISA
Middle Name:ANN
Last Name:FOSTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALISA
Other - Middle Name:ANN
Other - Last Name:COX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:615 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:COFFEYVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:67337-4919
Mailing Address - Country:US
Mailing Address - Phone:620-238-2289
Mailing Address - Fax:
Practice Address - Street 1:111 W DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:NOWATA
Practice Address - State:OK
Practice Address - Zip Code:74048-2616
Practice Address - Country:US
Practice Address - Phone:918-418-9594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-04
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty