Provider Demographics
NPI:1568752798
Name:FLOYD, KACI J (NP-C)
Entity Type:Individual
Prefix:
First Name:KACI
Middle Name:J
Last Name:FLOYD
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:979 E 3RD ST STE C-925
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2136
Mailing Address - Country:US
Mailing Address - Phone:423-778-5910
Mailing Address - Fax:423-778-5915
Practice Address - Street 1:979 E 3RD ST STE C-925
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2136
Practice Address - Country:US
Practice Address - Phone:423-778-5910
Practice Address - Fax:237-785-9154
Is Sole Proprietor?:No
Enumeration Date:2011-04-08
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN200664363L00000X
TN18126363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000211956AMedicaid
GA000211956AMedicaid
GA111815Medicare Oscar/Certification