MEDICARE: KRISTEN MICHELLE FLOYD RD, LD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133VN1005X	Renal Nutrition Registered Dietitian	1496	OK

General Provider Information

NPI Number	:	1629299987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN MICHELLE FLOYD RD, LD

Provider Business Mailing Address
First Line	:	1923 E 21ST ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74114-1402
Country	:	US
Telephone Number	:	918-744-3544
Fax Number	:	918-744-3341

Provider Business Practice Location Address
First Line	:	1923 E 21ST ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74114-1402
Country	:	US
Telephone Number	:	918-744-3544
Fax Number	:	918-744-3341

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	07/09/2007

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