Healthcare Provider Details

I. General information

NPI: 1831616820
Provider Name (Legal Business Name): ADDIE SNYDER PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2017
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3423 NW EVANGELINE TRWY
CARENCRO LA
70520-6241
US

IV. Provider business mailing address

PO BOX 82234
LAFAYETTE LA
70598-2234
US

V. Phone/Fax

Practice location:
  • Phone: 337-205-5855
  • Fax: 337-245-0445
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP09583
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: