Healthcare Provider Details

I. General information

NPI: 1245827658
Provider Name (Legal Business Name): COURTNEY CHEYENNE FLOYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2020
Last Update Date: 09/01/2021
Certification Date: 09/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 LANGDON ST
SOMERSET KY
42503-2750
US

IV. Provider business mailing address

97 WILLARD ST
MONTICELLO KY
42633-1780
US

V. Phone/Fax

Practice location:
  • Phone: 606-679-7441
  • Fax:
Mailing address:
  • Phone: 606-875-3150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3016446
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1131932
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: