Provider Demographics
NPI:1023043585
Name:FELKINS, JOHNNIE B (DPM)
Entity Type:Individual
Prefix:
First Name:JOHNNIE
Middle Name:B
Last Name:FELKINS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1901 MEDI PARK DR
Mailing Address - Street 2:STE 1054
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-2108
Mailing Address - Country:US
Mailing Address - Phone:806-322-4004
Mailing Address - Fax:806-322-7653
Practice Address - Street 1:1901 MEDI PARK DR
Practice Address - Street 2:STE 1054
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-2108
Practice Address - Country:US
Practice Address - Phone:806-322-4004
Practice Address - Fax:806-322-7653
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1721213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX612709Medicare PIN
TXV05306Medicare UPIN