Healthcare Provider Details

I. General information

NPI: 1689451320
Provider Name (Legal Business Name): FOOT SPECIALISTS OF KANSAS CITY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2023
Last Update Date: 09/14/2023
Certification Date: 09/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 W 151ST ST STE 120
OLATHE KS
66061-5300
US

IV. Provider business mailing address

8550 MARSHALL DR STE 120
LENEXA KS
66214-9836
US

V. Phone/Fax

Practice location:
  • Phone: 913-829-6800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number StateNULL

VIII. Authorized Official

Name: KRISTA NICOLE NELSON
Title or Position: DPM/OWNER
Credential:
Phone: 314-739-7100