Provider Demographics
NPI:1932925658
Name:FOSTER, JACKIE L (PA-C)
Entity type:Individual
Prefix:
First Name:JACKIE
Middle Name:L
Last Name:FOSTER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4011 TALBOT RD S STE 300
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5791
Mailing Address - Country:US
Mailing Address - Phone:425-656-5060
Mailing Address - Fax:425-656-5047
Practice Address - Street 1:150 ANDOVER PARK W
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-2801
Practice Address - Country:US
Practice Address - Phone:425-979-2663
Practice Address - Fax:425-524-4447
Is Sole Proprietor?:No
Enumeration Date:2024-11-26
Last Update Date:2025-05-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAPA.PA.61618587363A00000X
WAPA61618587363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2322947Medicaid