Healthcare Provider Details

I. General information

NPI: 1568388528
Provider Name (Legal Business Name): NIKITIA YVETTE MOORE-FLOYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S PIEDMONT ST
CALHOUN GA
30701-2422
US

IV. Provider business mailing address

202 WILLOWBROOK WAY SE
CALHOUN GA
30701-2108
US

V. Phone/Fax

Practice location:
  • Phone: 315-767-3232
  • Fax:
Mailing address:
  • Phone: 315-767-3232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT014668
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: