MEDICARE: MRS. TABITHA SNOWDY FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0200X	Infectious Disease Physician	R858634	MS
2	363L00000X	Nurse Practitioner	858634	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477580819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TABITHA SNOWDY FNP

Provider Business Mailing Address
First Line	:	5959 S SHERWOOD FOREST BLVD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-6038
Country	:	US
Telephone Number	:	601-200-4970
Fax Number	:	225-765-9196

Provider Business Practice Location Address
First Line	:	971 LAKELAND DR STE 954
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39216-4609
Country	:	US
Telephone Number	:	601-200-4714
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	03/20/2024

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