MEDICARE: MRS. KATHY BETH SNYDER RN

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	3145602	FL

General Provider Information

NPI Number	:	1962601518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHY BETH SNYDER RN

Provider Business Mailing Address
First Line	:	727 N US HIGHWAY 1
Second Line	:	VA PRIMARY CARE CLINIC
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-9125
Country	:	US
Telephone Number	:	772-595-5150
Fax Number	:	772-595-6560

Provider Business Practice Location Address
First Line	:	727 N US HIGHWAY 1
Second Line	:	VA PRIMARY CARE CLINIC
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-9125
Country	:	US
Telephone Number	:	772-595-5150
Fax Number	:	772-595-6560

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

Provider Enumeration Date	:	07/13/2007
Last Update Date	:	07/13/2007

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