Healthcare Provider Details

I. General information

NPI: 1689545097
Provider Name (Legal Business Name): FOOT SPECIALISTS OF KANSAS CITY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2025
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 NE 60TH ST
GLADSTONE MO
64119-2036
US

IV. Provider business mailing address

PO BOX 825159
PHILADELPHIA PA
19182-5159
US

V. Phone/Fax

Practice location:
  • Phone: 816-455-1155
  • Fax:
Mailing address:
  • Phone: 866-626-1540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

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