Provider Demographics
NPI:1619435716
Name:FOSTER, BOBBI LYN
Entity Type:Individual
Prefix:
First Name:BOBBI
Middle Name:LYN
Last Name:FOSTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:672 N RED OAK ST
Mailing Address - Street 2:
Mailing Address - City:ATOKA
Mailing Address - State:OK
Mailing Address - Zip Code:74525-1693
Mailing Address - Country:US
Mailing Address - Phone:580-364-4070
Mailing Address - Fax:
Practice Address - Street 1:672 N RED OAK ST
Practice Address - Street 2:
Practice Address - City:ATOKA
Practice Address - State:OK
Practice Address - Zip Code:74525-1693
Practice Address - Country:US
Practice Address - Phone:580-364-4070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-07
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK05Medicaid