Healthcare Provider Details

I. General information

NPI: 1174611818
Provider Name (Legal Business Name): ELIZABETH MARILYNN FELTNER DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 05/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 POPLAR STREET
KENOVA WV
25530
US

IV. Provider business mailing address

PO BOX 183
KENOVA WV
25530
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 StateNULL
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number00375
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number314
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: