Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 739736 | TX |
NPI | 1003199100 |
---|---|
Provider Name | Malotsha Anna Foster |
First Address | Killeen, TX 76549-2402 |
Second Address | Harker Heights, TX 76548-1343 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2011 |
Last Update Date | 19/03/2012 |