Provider Demographics
NPI:1891473690
Name:FOSTER, AMANDA ROBINSON (NP)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:ROBINSON
Last Name:FOSTER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:P
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1800 BUCKNER ST STE C120
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4453
Mailing Address - Country:US
Mailing Address - Phone:318-227-8899
Mailing Address - Fax:318-425-3793
Practice Address - Street 1:1800 BUCKNER ST STE C120
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4453
Practice Address - Country:US
Practice Address - Phone:318-227-8899
Practice Address - Fax:318-425-3793
Is Sole Proprietor?:No
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA231114363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner