Provider Demographics
NPI:1104814623
Name:SNYDER, TRACY L (RD)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:L
Last Name:SNYDER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:L
Other - Last Name:RIGGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:201 INDEPENDENCE DRIVE
Mailing Address - Street 2:BLDG 1100
Mailing Address - City:COLUMBUS AFB
Mailing Address - State:MS
Mailing Address - Zip Code:39705
Mailing Address - Country:US
Mailing Address - Phone:662-364-6020
Mailing Address - Fax:
Practice Address - Street 1:201 INDEPENDENCE DRIVE
Practice Address - Street 2:BLDG 1100
Practice Address - City:COLUMBUS AFB
Practice Address - State:MS
Practice Address - Zip Code:39705
Practice Address - Country:US
Practice Address - Phone:662-364-6020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered