Provider Demographics
NPI:1770747271
Name:FOSTER, DARRYL LYNN (PA-C)
Entity type:Individual
Prefix:MR
First Name:DARRYL
Middle Name:LYNN
Last Name:FOSTER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 OWEN DR
Mailing Address - Street 2:SUITE 103, BORDEAUX CENTER
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-1633
Mailing Address - Country:US
Mailing Address - Phone:910-223-7246
Mailing Address - Fax:
Practice Address - Street 1:3613 RAEFORD RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-2113
Practice Address - Country:US
Practice Address - Phone:910-483-0018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-00668363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical