Provider Demographics
NPI:1962786566
Name:FLOYD JAMES, KORTNEY (PHD, RN, CPNP)
Entity type:Individual
Prefix:
First Name:KORTNEY
Middle Name:
Last Name:FLOYD JAMES
Suffix:
Gender:F
Credentials:PHD, RN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 DUNAWAY CT
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-2202
Mailing Address - Country:US
Mailing Address - Phone:770-241-2048
Mailing Address - Fax:
Practice Address - Street 1:416 DUNAWAY CT
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:GA
Practice Address - Zip Code:30017-2202
Practice Address - Country:US
Practice Address - Phone:770-241-2048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-01
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN181122363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics