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Penni Smith Foster

Psychologist

Behavioral Health & Social Service Providers

PECOS Enrollment

Based on the most recent information from CMS, provider Penni Smith Foster does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 12:57 PM.

Profile Details

Provider ID
1780832717
Provider Type
Individual
Full Name
Foster, Penni Smith
Title
Dr.
Credential
PH.D.

Gender
Female
Sole Proprietor
No
Enumeration Date
9/3/2008
Last Updated
10/3/2013

Contact Information

Practice Location

2500 N State St, Jackson, MS 39216-4500

(601) 815-4233

(601) 815-5828

Mailing Location

2500 N State St, Jackson, MS 39216-4500

(601) 815-4233

(601) 815-5828

Provider Taxonomies

Code	Description	License
Code 103TC0700X Primary	Description Psychologist Behavioral Health & Social Service Providers	License 47822 Mississippi

Provider Identifiers

ID	Description	Issuer
ID 104746	Description Medicaid	Issuer Unlisted Alabama
ID 512I680047	Description Other	Issuer MEDICARE PTAN Mississippi
ID 05484026	Description Medicaid	Issuer Unlisted Mississippi

Penni Smith Foster

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

ID

Description

Issuer

ID

Description

Issuer

Logan, Patricia

Hermes, Susan F

Gratz, Kim L.

Young, Lashun A.

Burgess, Danny Ray

Crane, Kristi Leann

Gabriele, Jeanne Marisa

Schmidt, Nicholas

Lott, William C

Cox, Amanda