Provider Demographics
NPI:1639953409
Name:FLOYD, COURTNEY JADE (FNP)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:JADE
Last Name:FLOYD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 SANDLIN RD
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MS
Mailing Address - Zip Code:38843-2205
Mailing Address - Country:US
Mailing Address - Phone:662-322-4246
Mailing Address - Fax:
Practice Address - Street 1:200 MISSISSIPPI ST # 30
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:MS
Practice Address - Zip Code:38652-4140
Practice Address - Country:US
Practice Address - Phone:662-538-2150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-23
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS907402163W00000X
MS906305363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse