Provider Demographics
NPI:1356155014
Name:FOSTER, CARLIE RAY
Entity type:Individual
Prefix:
First Name:CARLIE
Middle Name:RAY
Last Name:FOSTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 SWEETWATER AVE
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:NE
Mailing Address - Zip Code:69301-2668
Mailing Address - Country:US
Mailing Address - Phone:308-760-5953
Mailing Address - Fax:
Practice Address - Street 1:924 CHEYENNE AVE
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:NE
Practice Address - Zip Code:69301-2948
Practice Address - Country:US
Practice Address - Phone:308-760-2007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant