Healthcare Provider Details

I. General information

NPI: 1659754026
Provider Name (Legal Business Name): BAMBI RACQUEL SNYDER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2015
Last Update Date: 11/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1895 ELIZABETHTOWN RD
LEITCHFIELD KY
42754-9138
US

IV. Provider business mailing address

908 WALLACE AVE
LEITCHFIELD KY
42754-1479
US

V. Phone/Fax

Practice location:
  • Phone: 270-230-0182
  • Fax: 270-230-0104
Mailing address:
  • Phone: 270-230-0182
  • Fax: 270-230-0104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3009451
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: