Healthcare Provider Details

I. General information

NPI: 1790455335
Provider Name (Legal Business Name): MELISSA DAWN FLOYD CPHT , CHW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2021
Last Update Date: 09/15/2021
Certification Date: 09/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1173 E HINES ST
REPUBLIC MO
65738-1277
US

IV. Provider business mailing address

1173 E HINES ST
REPUBLIC MO
65738-1277
US

V. Phone/Fax

Practice location:
  • Phone: 417-735-0055
  • Fax: 417-732-1529
Mailing address:
  • Phone: 417-735-0055
  • Fax: 417-732-1529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number2009033721
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number13845
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: