Individual
DR. PENNI SMITH FOSTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 815-4233
(601) 815-5828
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 815-4233
(601) 815-5828
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
47822
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05484026
—
MS
05
—
104746
—
AL
01
—
512I680047
MEDICARE PTAN
MS
Enumeration date
09/03/2008
Last updated
10/03/2013
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