Healthcare Provider Details

I. General information

NPI: 1669127882
Provider Name (Legal Business Name): JENNIFER L SNYDER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER L COX

II. Dates (important events)

Enumeration Date: 02/16/2022
Last Update Date: 02/25/2022
Certification Date: 02/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4015 GATEWAY BLVD
NEWBURGH IN
47630-8925
US

IV. Provider business mailing address

PO BOX 1510
EVANSVILLE IN
47706-1510
US

V. Phone/Fax

Practice location:
  • Phone: 812-858-9400
  • Fax: 812-858-9571
Mailing address:
  • Phone: 812-858-9400
  • Fax: 812-858-9571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number28227380A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71012292A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: