Provider Demographics
NPI:1699426080
Name:SNOW, KIMBERLY NICOLE (APRN)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:NICOLE
Last Name:SNOW
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 MINNESOTA AVE
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-2655
Mailing Address - Country:US
Mailing Address - Phone:850-532-0685
Mailing Address - Fax:
Practice Address - Street 1:1209 MINNESOTA AVE
Practice Address - Street 2:
Practice Address - City:LYNN HAVEN
Practice Address - State:FL
Practice Address - Zip Code:32444-2655
Practice Address - Country:US
Practice Address - Phone:850-532-0685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-17
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11013955363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care