Provider Demographics
NPI:1962601518
Name:SNYDER, KATHY BETH (RN)
Entity type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:BETH
Last Name:SNYDER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 N US HIGHWAY 1
Mailing Address - Street 2:VA PRIMARY CARE CLINIC
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-9125
Mailing Address - Country:US
Mailing Address - Phone:772-595-5150
Mailing Address - Fax:772-595-6560
Practice Address - Street 1:727 N US HIGHWAY 1
Practice Address - Street 2:VA PRIMARY CARE CLINIC
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-9125
Practice Address - Country:US
Practice Address - Phone:772-595-5150
Practice Address - Fax:772-595-6560
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3145602163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse