Provider Demographics
NPI:1104153709
Name:FLOYD, DIANA M (RD, LD)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:M
Last Name:FLOYD
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:M
Other - Last Name:POLSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:100 E HELEN ST
Mailing Address - Street 2:
Mailing Address - City:HERINGTON
Mailing Address - State:KS
Mailing Address - Zip Code:67449-1606
Mailing Address - Country:US
Mailing Address - Phone:785-258-2207
Mailing Address - Fax:785-258-3535
Practice Address - Street 1:100 E HELEN ST
Practice Address - Street 2:
Practice Address - City:HERINGTON
Practice Address - State:KS
Practice Address - Zip Code:67449-1606
Practice Address - Country:US
Practice Address - Phone:785-258-2207
Practice Address - Fax:785-258-3535
Is Sole Proprietor?:No
Enumeration Date:2009-11-03
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS134133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS130630Medicare PIN