MEDICARE: KELLIE SNYDER

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	163W00000X	Registered Nurse	309482	AZ

General Provider Information

NPI Number	:	1942152749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLIE SNYDER

Provider Business Mailing Address
First Line	:	10121 E GAMMA AVE
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85212-9221
Country	:	US
Telephone Number	:	360-280-5149
Fax Number	:

Provider Business Practice Location Address
First Line	:	560 W BROWN RD STE 1011
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85201-3222
Country	:	US
Telephone Number	:	360-280-5149
Fax Number	:

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

Provider Enumeration Date	:	02/12/2026
Last Update Date	:	02/12/2026

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Directions to “ KELLIE SNYDER ” Practice Location

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