Provider Demographics
NPI:1952915092
Name:FOSTER, MISSY BROWN (FNP-BC)
Entity type:Individual
Prefix:MS
First Name:MISSY
Middle Name:BROWN
Last Name:FOSTER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 KRISTY LN
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-7424
Mailing Address - Country:US
Mailing Address - Phone:662-266-4010
Mailing Address - Fax:
Practice Address - Street 1:11630 HIGHWAY 51 S
Practice Address - Street 2:
Practice Address - City:ATOKA
Practice Address - State:TN
Practice Address - Zip Code:38004-7129
Practice Address - Country:US
Practice Address - Phone:901-837-5020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-05
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS895127163W00000X
MS904561363LF0000X
TN29427363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse