Healthcare Provider Details

I. General information

NPI: 1184540254
Provider Name (Legal Business Name): HAPPY FEET PODIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 W COMMERCIAL ST
KAHOKA MO
63445-1411
US

IV. Provider business mailing address

PO BOX 38
KAHOKA MO
63445-0038
US

V. Phone/Fax

Practice location:
  • Phone: 660-727-6890
  • Fax: 660-727-6249
Mailing address:
  • Phone: 660-727-6890
  • Fax: 660-727-6249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: NICOLE DAVIS
Title or Position: ADVISOR
Credential:
Phone: 660-727-6890