Provider Demographics
NPI:1619256690
Name:FOSTER, JOSHUA A (CRNA)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:A
Last Name:FOSTER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 JULEE CIR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-6003
Mailing Address - Country:US
Mailing Address - Phone:601-906-8765
Mailing Address - Fax:
Practice Address - Street 1:409 JULEE CIR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-6003
Practice Address - Country:US
Practice Address - Phone:601-906-8765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-09
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR865752367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered