Healthcare Provider Details

I. General information

NPI: 1629807797
Provider Name (Legal Business Name): KIMBERLEE JO SNIDER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLEE JO MARS RN

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 17TH ST
WOODWARD OK
73801-2448
US

IV. Provider business mailing address

42870 S COUNTY ROAD 214
MOORELAND OK
73852-9038
US

V. Phone/Fax

Practice location:
  • Phone: 580-254-5511
  • Fax:
Mailing address:
  • Phone: 580-574-4927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberR0105078
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF0741269
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: