Provider Demographics
NPI:1174611818
Name:FELTNER, ELIZABETH MARILYNN (DPM)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MARILYNN
Last Name:FELTNER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 183
Mailing Address - Street 2:
Mailing Address - City:KENOVA
Mailing Address - State:WV
Mailing Address - Zip Code:25530
Mailing Address - Country:US
Mailing Address - Phone:304-453-5458
Mailing Address - Fax:304-453-5459
Practice Address - Street 1:1102 POPLAR STREET
Practice Address - Street 2:
Practice Address - City:KENOVA
Practice Address - State:WV
Practice Address - Zip Code:25530
Practice Address - Country:US
Practice Address - Phone:304-453-5458
Practice Address - Fax:304-453-5459
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV00375213E00000X
KY314213E00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2102034000Medicaid
4907030001OtherDME
U94604Medicare UPIN
WVSP04801Medicare PIN