=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942161385
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHASITY LYNN SNOWDEN FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/24/2025
-----------------------------------------------------
Last Update Date | 12/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1515 E CLARK ST
-----------------------------------------------------
City | POCATELLO
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83201-4133
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-233-2273
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4534 POCAHONTAS DR
-----------------------------------------------------
City | CHUBBUCK
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83202-1745
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-406-8858
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 5871987
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------