Healthcare Provider Details

I. General information

NPI: 1417880865
Provider Name (Legal Business Name): KETTY N FLOYD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 S 10TH AVE FL 1
MOUNT VERNON NY
10550-3746
US

IV. Provider business mailing address

252 S 10TH AVE FL 1
MOUNT VERNON NY
10550-3746
US

V. Phone/Fax

Practice location:
  • Phone: 914-512-4980
  • Fax:
Mailing address:
  • Phone: 914-512-4980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number420688
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number487739
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: