Provider Demographics
NPI:1942230487
Name:FOSTER, JULIA L (NP)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:L
Last Name:FOSTER
Suffix:
Gender:F
Credentials:NP
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 3810
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803
Mailing Address - Country:US
Mailing Address - Phone:417-347-8750
Mailing Address - Fax:417-347-8788
Practice Address - Street 1:1030 MCINTOSH CIRCLE
Practice Address - Street 2:STE 1
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804
Practice Address - Country:US
Practice Address - Phone:417-347-8750
Practice Address - Fax:417-347-8788
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO083008363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100184580AMedicaid
KS100301490AMedicaid
MO162892OtherANTHEM
MO428941603Medicaid