Provider Demographics
NPI:1851379234
Name:FOLTZ, KELLEY D (DPM)
Entity Type:Individual
Prefix:DR
First Name:KELLEY
Middle Name:D
Last Name:FOLTZ
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 801143
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-1143
Mailing Address - Country:US
Mailing Address - Phone:573-331-5583
Mailing Address - Fax:573-331-5079
Practice Address - Street 1:1012 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SIKESTON
Practice Address - State:MO
Practice Address - Zip Code:63801-5044
Practice Address - Country:US
Practice Address - Phone:573-471-0330
Practice Address - Fax:573-471-0461
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004004897213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO430741410OtherFIRST HEALTH NUMBER
MO43074141063801A011OtherTRICARE NUMBER
MO308362201Medicaid
MO191541OtherBCBS MO NUMBER
MO675096OtherHEALTHLINK NUMBER
MOV03979Medicare UPIN
MO308362201Medicaid