Provider Demographics
NPI:1326725466
Name:FOSTER, KEELIAN M (FNP)
Entity type:Individual
Prefix:
First Name:KEELIAN
Middle Name:M
Last Name:FOSTER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 E 2ND ST STE G
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-5423
Mailing Address - Country:US
Mailing Address - Phone:432-332-5200
Mailing Address - Fax:432-332-5201
Practice Address - Street 1:601 E 2ND ST STE G
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-5423
Practice Address - Country:US
Practice Address - Phone:432-332-5200
Practice Address - Fax:432-332-5201
Is Sole Proprietor?:No
Enumeration Date:2023-06-30
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1126416363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily