Healthcare Provider Details

I. General information

NPI: 1982248571
Provider Name (Legal Business Name): MELISSA JO FERRILL FLOYD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2019
Last Update Date: 12/30/2020
Certification Date: 12/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70411 HIGHWAY 21
COVINGTON LA
70433-8243
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 985-400-5566
  • Fax: 985-400-5560
Mailing address:
  • Phone: 225-765-5727
  • Fax: 225-765-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number208682
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: