Healthcare Provider Details

I. General information

NPI: 1477580819
Provider Name (Legal Business Name): TABITHA SNOWDY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TABITHA WELLS

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

971 LAKELAND DR STE 954
JACKSON MS
39216-4609
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 601-200-4714
  • Fax:
Mailing address:
  • Phone: 601-200-4970
  • Fax: 225-765-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberR858634
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number858634
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: