Basic Information
| Provider Information | |||||||||
| NPI: | 1326070699 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | FLOYD | ||||||||
| FirstName: | JAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 102 W 18TH ST | ||||||||
| Address2: | |||||||||
| City: | HOPKINSVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 422401961 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707072100 | ||||||||
| FaxNumber: | 2707072103 | ||||||||
| Practice Location | |||||||||
| Address1: | 222 W 18TH ST | ||||||||
| Address2: | |||||||||
| City: | HOPKINSVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 422401963 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2708864625 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 56349 | TN | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | MD425732 | PA | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 39053 | KY | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 7100236300 | 05 | KY | MEDICAID |