Healthcare Provider Details

I. General information

NPI: 1851430565
Provider Name (Legal Business Name): KATHERINE LEE SNYDER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1233 SOUTHWEST AVENUE EXTENSION NORTHEAST TENNESSEE REGIONAL OFFICE
JOHNSON CITY TN
37604-6519
US

IV. Provider business mailing address

441 STANFIELD RD
BLUFF CITY TN
37618-3433
US

V. Phone/Fax

Practice location:
  • Phone: 423-979-3200
  • Fax: 423-979-3261
Mailing address:
  • Phone: 423-538-9135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN0000093999
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: