1407628746 NPI number — DR. KELSIE NICHELLE FOSTER PH.D CRC

Table of content: DR. KELSIE NICHELLE FOSTER PH.D CRC (NPI 1407628746)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407628746 NPI number — DR. KELSIE NICHELLE FOSTER PH.D CRC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FOSTER
Provider First Name:
KELSIE
Provider Middle Name:
NICHELLE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D CRC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407628746
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
95 MULBERRY DR UNIT 3-103
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH KINGSTOWN
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02852-4588
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-857-6553
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5600 POST RD STE 114-193
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST GREENWICH
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02818-3400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-443-0385
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/30/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC1900X , with the licence number:  PS02089 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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