Healthcare Provider Details

I. General information

NPI: 1336593292
Provider Name (Legal Business Name): LARRY DEWAYNE SNEED APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2016
Last Update Date: 12/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

764 BECKRIDGE RD
MCMINNVILLE TN
37110-7479
US

IV. Provider business mailing address

203 AVALON AVE STE 320
MUSCLE SHOALS AL
35661-2880
US

V. Phone/Fax

Practice location:
  • Phone: 931-304-6003
  • Fax:
Mailing address:
  • Phone: 615-896-7440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3011769
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number82405
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: