Provider Demographics
NPI:1790742773
Name:FLOYD, KATHLEEN A (FNP BC)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:A
Last Name:FLOYD
Suffix:
Gender:F
Credentials:FNP BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 STOCKBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GREAT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230-1295
Mailing Address - Country:US
Mailing Address - Phone:413-528-8580
Mailing Address - Fax:413-528-8586
Practice Address - Street 1:444 STOCKBRIDGE RD
Practice Address - Street 2:
Practice Address - City:GREAT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230-1295
Practice Address - Country:US
Practice Address - Phone:413-528-8580
Practice Address - Fax:413-528-8586
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA179335363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0357341Medicaid
MA0357341Medicaid
NP2638Medicare PIN