Provider Demographics
NPI:1205928108
Name:FOSTER, MELISSA A (FNP-C)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:FOSTER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 ARROWHEAD DR
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82930-9266
Mailing Address - Country:US
Mailing Address - Phone:307-789-3636
Mailing Address - Fax:
Practice Address - Street 1:711 ONYX ST
Practice Address - Street 2:
Practice Address - City:KEMMERER
Practice Address - State:WY
Practice Address - Zip Code:83101-3214
Practice Address - Country:US
Practice Address - Phone:307-877-4496
Practice Address - Fax:307-877-9769
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY17739.156363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY112230400Medicaid
WY304030OtherBLUE CROSS/BLUE SHIELD
WY110155003Medicare ID - Type UnspecifiedRAILROAD MEDICARE
WY304030OtherBLUE CROSS/BLUE SHIELD
WY112230400Medicaid