Basic Information
| Provider Information | |||||||||
| NPI: | 1891318598 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FOSTER | ||||||||
| FirstName: | KENDRA | ||||||||
| MiddleName: | RAE | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5079 S LICK CREEK RD | ||||||||
| Address2: | |||||||||
| City: | MORGANTOWN | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461609300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3176106298 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1302 S ROGERS ST | ||||||||
| Address2: | |||||||||
| City: | BLOOMINGTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 474034752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8123533700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2020 | ||||||||
| LastUpdateDate: | 02/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 28223524A | IN | N | Nursing Service Providers | Registered Nurse | 363L00000X | 71010718A | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.