Provider Demographics
NPI:1437208782
Name:FOLTZ, FREDERICK EMMONEL (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:EMMONEL
Last Name:FOLTZ
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 SHADOWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-9611
Mailing Address - Country:US
Mailing Address - Phone:270-889-0115
Mailing Address - Fax:
Practice Address - Street 1:1102 SOUTH VIRGINIA STREET
Practice Address - Street 2:DR JEFFEREY RIGGS DO LLC
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-5821
Practice Address - Country:US
Practice Address - Phone:270-885-7198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1055363A00000X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYKY1055OtherKENTUCKY STATE LICENSE
KY7100024730Medicaid
KY000000541933OtherBLUE CROSS AND BLUE SHIELD OF KENTUCKY
KY000000541933OtherBLUE CROSS AND BLUE SHIELD OF KENTUCKY
KY00486002Medicare PIN