Provider Demographics
NPI:1891920088
Name:FOSTER, DANIELLE CRYSTIN KENNEDY (DO)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:CRYSTIN KENNEDY
Last Name:FOSTER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9200 SHELBYVILLE RD STE 530
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-5149
Mailing Address - Country:US
Mailing Address - Phone:502-953-4799
Mailing Address - Fax:
Practice Address - Street 1:1621 NASHVILLE ST
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:KY
Practice Address - Zip Code:42276-8871
Practice Address - Country:US
Practice Address - Phone:270-946-1372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-18
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY03471208000000X
KYR2226208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics