Healthcare Provider Details

I. General information

NPI: 1144711326
Provider Name (Legal Business Name): JENNA A. SNYDER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNA A. SALTSGAVER PA-C

II. Dates (important events)

Enumeration Date: 05/23/2018
Last Update Date: 11/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 MACCORKLE AVE SE SUITE B16
CHARLESTON WV
25304
US

IV. Provider business mailing address

PO BOX 1547
CHARLESTON WV
25326-1547
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-5848
  • Fax: 304-388-9654
Mailing address:
  • Phone: 304-388-1724
  • Fax: 304-388-1721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2176
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: