MEDICARE: MRS. KATHRYN A SNOW-MCCAFFREY APRN MSN GNP

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	363LG0600X	Gerontology Nurse Practitioner	KS097301	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00356871	OTHER	MI	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5008769310	OTHER	MI	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487625174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHRYN A SNOW-MCCAFFREY APRN MSN GNP

Provider Business Mailing Address
First Line	:	7268 CAMPBELL TRL
Second Line	:
City	:	INDIAN RIVER
State	:	MI
Zip	:	49749-9221
Country	:	US
Telephone Number	:	231-420-3887
Fax Number	:	231-526-2212

Provider Business Practice Location Address
First Line	:	7268 CAMPBELL TRL
Second Line	:
City	:	INDIAN RIVER
State	:	MI
Zip	:	49749-9221
Country	:	US
Telephone Number	:	231-420-3887
Fax Number	:	231-526-2212

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

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	05/30/2019

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