| Abundantly Fruitful | |
|
1621 Central Ave Ste 8525 Cheyenne WY 82001-4531 | |
| (626) 716-7390 | |
| Not Available |
| Full Name | Abundantly Fruitful |
|---|---|
| Speciality | Clinic/Center |
| Location | 1621 Central Ave Ste 8525, Cheyenne, Wyoming |
| Authorized Official Name and Position | La Valle Foster (CEO) |
| Authorized Official Contact | 6267167390 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Abundantly Fruitful 1621 Central Ave Ste 8525 Cheyenne WY 82001-4531 | Abundantly Fruitful 1621 Central Ave Ste 8525 Cheyenne WY 82001-4531 Ph: (626) 716-7390 |
| NPI Number | 1528855194 |
|---|---|
| Provider Enumeration Date | 04/24/2025 |
| Last Update Date | 04/24/2025 |
| Certification Date | 04/24/2025 |
| Medicare PECOS PAC ID | 4688171762 |
|---|---|
| Medicare Enrollment ID | O20251007000800 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528855194 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | () | Primary |
| Provider Name | Kevin Foster |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1184851545 PECOS PAC ID: 8224382213 Enrollment ID: I20181109001277 |
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