Provider Demographics
NPI:1245921857
Name:FOSTER, BERRY DONOVAN (FNP-BC)
Entity type:Individual
Prefix:
First Name:BERRY
Middle Name:DONOVAN
Last Name:FOSTER
Suffix:
Gender:M
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 1:208 GRANITE HILL TRL
Mailing Address - Street 2:
Mailing Address - City:PELZER
Mailing Address - State:SC
Mailing Address - Zip Code:29669-9421
Mailing Address - Country:US
Mailing Address - Phone:352-464-2614
Mailing Address - Fax:
Practice Address - Street 1:8 N TEXAS AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29611-5034
Practice Address - Country:US
Practice Address - Phone:864-295-1331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-16
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27357363LF0000X
SCAPN.27357363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily