Provider Demographics
NPI:1457515363
Name:FOSTER, JESSICA LYN (APRN)
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:LYN
Last Name:FOSTER
Suffix:
Gender:F
Credentials:APRN
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Mailing Address - Street 1:3805 CHEROKEE ST NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-2085
Mailing Address - Country:US
Mailing Address - Phone:770-426-5666
Mailing Address - Fax:770-426-9212
Practice Address - Street 1:3805 CHEROKEE ST NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-2085
Practice Address - Country:US
Practice Address - Phone:770-426-5666
Practice Address - Fax:770-426-9212
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2016-05-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GARN 159786 NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA874033748BMedicaid