Provider Demographics
NPI:1265137723
Name:FOSTER, ASHLEY BROOKE (PA-C)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:BROOKE
Last Name:FOSTER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:BROOKE
Other - Last Name:TRUMBLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1455 E BERT KOUNS INDUSTRIAL LOOP
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-6000
Mailing Address - Country:US
Mailing Address - Phone:318-798-4544
Mailing Address - Fax:
Practice Address - Street 1:1455 E BERT KOUNS INDUSTRIAL LOOP STE 108
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-6000
Practice Address - Country:US
Practice Address - Phone:318-798-4544
Practice Address - Fax:318-798-4557
Is Sole Proprietor?:No
Enumeration Date:2023-04-04
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1199752363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant