Provider Demographics
NPI:1427069426
Name:FLOYD, KIMBERLY CIARLETTA (M ED, RD, LD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:CIARLETTA
Last Name:FLOYD
Suffix:
Gender:F
Credentials:M ED, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1519 BROGDON ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-2116
Mailing Address - Country:US
Mailing Address - Phone:912-352-1564
Mailing Address - Fax:
Practice Address - Street 1:1519 BROGDON ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2116
Practice Address - Country:US
Practice Address - Phone:912-352-1564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD000267133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered