Melissa Dawn Floyd, CPHT , CHW-C

Individual provider Active NPI Community Health Worker · Republic, MO

NPI 1790455335 · NPPES record last updated Sep 15, 2021

Key facts

NPI
1790455335
Entity type
Individual (NPI type 1)
Primary specialty
Community Health Worker 172V00000X
License
13845 (MO)
Practice address
1173 E Hines St
Republic, MO 65738-1277
Phone
(417) 735-0055
Fax
(417) 732-1529
NPI assigned
Sep 15, 2021
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
13845MOMDCommunity Health Worker
2009033721MOMDPharmacy Technician

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy Technician 183700000X 2009033721 MO
Community Health Worker 172V00000X 13845 MO Yes

Addresses

Primary practice location

1173 E Hines St
Republic, MO 65738-1277

Mailing address

1173 E Hines St
Republic, MO 65738-1277
Phone (417) 735-0055

Other providers in Republic, MO

All providers in Republic, MO · Community Health Worker in Missouri

Sources for this page

Verify at the official NPI Registry.