Provider Demographics
NPI:1548879059
Name:FLOYD, LYDIA J (APRN)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:J
Last Name:FLOYD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:LYDIA
Other - Middle Name:J
Other - Last Name:TRIMBLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:245 FLEMINGSBURG RD STE A340
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-1015
Mailing Address - Country:US
Mailing Address - Phone:606-207-2931
Mailing Address - Fax:
Practice Address - Street 1:245 FLEMINGSBURG RD STE A340
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-1015
Practice Address - Country:US
Practice Address - Phone:606-207-2931
Practice Address - Fax:606-783-0964
Is Sole Proprietor?:No
Enumeration Date:2020-07-30
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3014710363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100684340Medicaid