Healthcare Provider Details

I. General information

NPI: 1164604922
Provider Name (Legal Business Name): E MARILYNN FELTNER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2007
Last Update Date: 12/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 POPLAR ST
KENOVA WV
25530-1339
US

IV. Provider business mailing address

PO BOX 183
KENOVA WV
25530-0183
US

V. Phone/Fax

Practice location:
  • Phone: 304-453-5458
  • Fax: 304-453-5459
Mailing address:
  • Phone: 304-453-5458
  • Fax: 304-453-5459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. ELIZABETH MARILYNN FELTNER
Title or Position: SOLE PROPRIETOR
Credential: DPM
Phone: 304-453-5458