Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 28915 | TN |
NPI | 1003404831 |
---|---|
Provider Name | Gary Clinton Foster |
First Address | Martin, TN 38237-8503 |
Second Address | Martin, TN 38237-8503 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2021 |
Last Update Date | 07/01/2021 |