Healthcare Provider Details

I. General information

NPI: 1265416341
Provider Name (Legal Business Name): KIMBERLY A SNYDER APRN BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 CHESTER BLVD SUITE 2
RICHMOND IN
47374-1943
US

IV. Provider business mailing address

1100 REID PKWY MEDICAL STAFF SERVICES
RICHMOND IN
47374-1157
US

V. Phone/Fax

Practice location:
  • Phone: 765-935-8581
  • Fax: 765-935-1171
Mailing address:
  • Phone: 765-935-8581
  • Fax: 765-935-1171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number71000483
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: