Individual
FREDERICK EMMONEL FOLTZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
1102 SOUTH VIRGINIA STREET, DR JEFFEREY RIGGS DO LLC, HOPKINSVILLE, KY 42240-5821
(270) 885-7198
Mailing address
130 SHADOWOOD TRL, HOPKINSVILLE, KY 42240-9611
(270) 889-0115
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1055
KY
363AM0700X
Medical Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000541933
BLUE CROSS AND BLUE SHIELD OF KENTUCKY
KY
05
—
7100024730
—
KY
01
—
KY1055
KENTUCKY STATE LICENSE
KY
Enumeration date
01/09/2007
Last updated
03/07/2023
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