Healthcare Provider Details

I. General information

NPI: 1548879059
Provider Name (Legal Business Name): LYDIA J FLOYD APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LYDIA J TRIMBLE

II. Dates (important events)

Enumeration Date: 07/30/2020
Last Update Date: 05/04/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 FLEMINGSBURG RD STE A340
MOREHEAD KY
40351-1015
US

IV. Provider business mailing address

245 FLEMINGSBURG RD STE A340
MOREHEAD KY
40351-1015
US

V. Phone/Fax

Practice location:
  • Phone: 606-207-2931
  • Fax: 606-783-0964
Mailing address:
  • Phone: 606-207-2931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3014710
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: