Provider Demographics
NPI:1225631666
Name:FLOYD, PAMELA VIRGINIA
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:VIRGINIA
Last Name:FLOYD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 102
Mailing Address - Street 2:
Mailing Address - City:WELLSTON
Mailing Address - State:OH
Mailing Address - Zip Code:45692-0102
Mailing Address - Country:US
Mailing Address - Phone:740-418-8716
Mailing Address - Fax:740-384-2851
Practice Address - Street 1:23935 STATE ROUTE 93
Practice Address - Street 2:
Practice Address - City:WELLSTON
Practice Address - State:OH
Practice Address - Zip Code:45692
Practice Address - Country:US
Practice Address - Phone:740-418-8716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0420178374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide