Provider Demographics
NPI:1689600918
Name:IKERD, VALARIE L (DPM)
Entity Type:Individual
Prefix:
First Name:VALARIE
Middle Name:L
Last Name:IKERD
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 1:1501 E 20TH ST
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-0928
Mailing Address - Country:US
Mailing Address - Phone:417-659-9395
Mailing Address - Fax:417-659-9565
Practice Address - Street 1:1501 E 20TH ST
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-0928
Practice Address - Country:US
Practice Address - Phone:417-659-9395
Practice Address - Fax:417-659-9565
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000729213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO284033OtherHEALTHLINK
MO431842730OtherTRICARE WEST
MO308222207Medicaid
MO112612OtherBCBS MO
MO214230001Medicare PIN
MO431842730OtherTRICARE WEST
MO480028651Medicare PIN