Provider Demographics
NPI:1316266414
Name:FOSTER, BRIAN I
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:
Last Name:FOSTER
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 DUNCAN DR
Mailing Address - Street 2:
Mailing Address - City:ATOKA
Mailing Address - State:TN
Mailing Address - Zip Code:38004-7875
Mailing Address - Country:US
Mailing Address - Phone:901-837-9583
Mailing Address - Fax:
Practice Address - Street 1:1900 EXETER RD
Practice Address - Street 2:SUITE 210
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-2954
Practice Address - Country:US
Practice Address - Phone:901-818-2183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-28
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN 15231367500000X
TNRN0000135168163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1521696Medicaid
MS05656310Medicaid
1316266414OtherCHAMPUS/HUMANA TRICARE
TN4274309OtherBLUE CROSS
AR186483001Medicaid
TNP00907123OtherRAILROAD MEDICARE
TN1521696Medicaid