Healthcare Provider Details

I. General information

NPI: 1558649848
Provider Name (Legal Business Name): KIMBERLY SNYDER MSN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2011
Last Update Date: 10/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1048 ASHLEY ST STE 103A
BOWLING GREEN KY
42103-2449
US

IV. Provider business mailing address

600 CROSS POINTE RD STE A
GAHANNA OH
43230-6696
US

V. Phone/Fax

Practice location:
  • Phone: 270-599-0958
  • Fax:
Mailing address:
  • Phone: 513-725-2186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3008826
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: