Provider Demographics
NPI:1649576281
Name:FOSTER, KRISTEN SARAH (PA-C, PHD)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:SARAH
Last Name:FOSTER
Suffix:
Gender:F
Credentials:PA-C, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1648
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97440-1648
Mailing Address - Country:US
Mailing Address - Phone:541-284-1600
Mailing Address - Fax:541-242-4634
Practice Address - Street 1:1007 HARLOW RD
Practice Address - Street 2:SUITE 210
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-7124
Practice Address - Country:US
Practice Address - Phone:541-284-1600
Practice Address - Fax:541-242-4634
Is Sole Proprietor?:No
Enumeration Date:2011-01-30
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA156054363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500638168Medicaid