Provider Demographics
NPI:1124355136
Name:SNYDER, CAROLYN ALLISA (RD, LD)
Entity type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:ALLISA
Last Name:SNYDER
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 S BRADFORD ST
Mailing Address - Street 2:NONE
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-5403
Mailing Address - Country:US
Mailing Address - Phone:785-317-5440
Mailing Address - Fax:660-730-5042
Practice Address - Street 1:701 S BRADFORD ST
Practice Address - Street 2:NONE
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-5403
Practice Address - Country:US
Practice Address - Phone:785-317-5440
Practice Address - Fax:660-730-5042
Is Sole Proprietor?:No
Enumeration Date:2009-11-11
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1376133V00000X
MO2013014801133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered