Provider Demographics
NPI:1740626225
Name:FOSTER, WAYNE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:
Last Name:FOSTER
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8406 LE MARIE CT
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70706-1536
Mailing Address - Country:US
Mailing Address - Phone:225-505-6013
Mailing Address - Fax:225-928-2498
Practice Address - Street 1:8406 LE MARIE CT
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70706-1536
Practice Address - Country:US
Practice Address - Phone:225-505-6013
Practice Address - Fax:225-928-2498
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-10
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07313363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health