Basic Information
| Provider Information | |||||||||
| NPI: | 1922620566 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FLOYD | ||||||||
| FirstName: | BILLY | ||||||||
| MiddleName: | W | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2926 LEE ELLEN PL | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432073721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142162869 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7400 HUNTINGTON PARK DR | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432355617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145050378 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2020 | ||||||||
| LastUpdateDate: | 07/29/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 099197 | OH | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.