Individual provider Active NPI

Jackie L. Foster, PA-C

  • Surgical Physician Assistant
  • Tukwila, WA
National Provider Identifier
1932925658
Registry record updated May 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA61618587 Issued in WA
Practice address
150 Andover Park W
Tukwila, WA 98188-2801
Phone
(425) 979-2663
Fax
(425) 524-4447
NPI assigned
Nov 26, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 29, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA.PA.61618587 WA
Surgical Physician Assistant 363AS0400X PA61618587 WA Primary

Addresses

Primary practice location

150 Andover Park W
Tukwila, WA 98188-2801

Mailing address

4011 Talbot Rd S Ste 300
Renton, WA 98055-5791
Phone (425) 656-5060

Other identifiers 1

IdentifierTypeStateIssuer
2322947MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250610001626 WA Practitioner - Physician Assistant 6305356270 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Proliance Surgeons Inc P SGroup PAC ID 8527972900, 395 clinicians

Practice addresses (Care Compare)

150 Andover Park W
Tukwila, WA 98188-2801
Phone (425) 979-2663

27005 168TH PL SE
Suite 201
Covington, WA 98042-4902
Phone (253) 630-3660

4011 Talbot Rd S
Suite 300
Renton, WA 98055-5791
Phone (206) 656-5060

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA.PA.61618587WAMDPhysician Assistant
PA61618587WAMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Proliance Surgeons Inc P S Surgical CurrentSince May 19, 2025 Accepting new patients
Proliance Surgeons, Inc., P.S. CurrentSince May 19, 2025 Accepting new patients
Proliance Surgeons, Inc., P.S. Past Accepting new patients

Locations

3600 Lind Ave SW
Ste 170
Renton, WA 98057
Phone (425) 656-4260

4011 Talbot Rd S
Ste 300
Renton, WA 98055
Phone (206) 656-5060

805 Madison St
Ste 901
Seattle, WA 98104
Phone (206) 264-8100

150 Andover Park W
Tukwila, WA 98188
Phone (425) 979-2663

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1732579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748476800000",
    "number": "1932925658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4011 TALBOT RD S STE 300",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980555791",
            "telephone_number": "425-656-5060",
            "fax_number": "425-656-5047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 ANDOVER PARK W",
            "city": "TUKWILA",
            "state": "WA",
            "postal_code": "981882801",
            "telephone_number": "425-979-2663",
            "fax_number": "425-524-4447"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOSTER",
        "first_name": "JACKIE",
        "middle_name": "L.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-11-26",
        "last_updated": "2025-05-29",
        "certification_date": "2025-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA.PA.61618587",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "WA",
            "license": "PA61618587",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2322947",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tukwila, WA

Sources for this page

Verify at the official NPI Registry.