Provider Demographics
NPI:1699742205
Name:FOUST, DAPHNE TRACY (PA-C)
Entity type:Individual
Prefix:MRS
First Name:DAPHNE
Middle Name:TRACY
Last Name:FOUST
Suffix:
Gender:F
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 1:849 VOLUNTEER DR STE 2
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-5483
Mailing Address - Country:US
Mailing Address - Phone:731-540-7075
Mailing Address - Fax:731-227-2887
Practice Address - Street 1:849 VOLUNTEER DR STE 2
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-5483
Practice Address - Country:US
Practice Address - Phone:731-540-7075
Practice Address - Fax:731-227-2887
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA229363AS0400X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3380640OtherMEDICAID GROUP
TN3663231OtherMEDICAID
TN3380640OtherMEDICARE GROUP
TN229OtherPA LICENSE
TN3380640OtherMEDICAID GROUP