Provider Demographics
NPI:1013484872
Name:FOSTER, MELISSA ALLEN (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:ALLEN
Last Name:FOSTER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3228 FOUNTAIN PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-2956
Mailing Address - Country:US
Mailing Address - Phone:865-771-2321
Mailing Address - Fax:
Practice Address - Street 1:3228 FOUNTAIN PARK BLVD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-2956
Practice Address - Country:US
Practice Address - Phone:865-771-2321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25097363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN25097OtherAPRN LICENSE NUMBER