Provider Demographics
NPI:1992108435
Name:SNYDER, KATHERINE ANN (LD, RD, CDE)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANN
Last Name:SNYDER
Suffix:
Gender:F
Credentials:LD, RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 S PEORIA AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74120-3820
Mailing Address - Country:US
Mailing Address - Phone:918-588-1900
Mailing Address - Fax:918-582-6405
Practice Address - Street 1:550 S PEORIA AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-3820
Practice Address - Country:US
Practice Address - Phone:918-588-1900
Practice Address - Fax:918-582-6405
Is Sole Proprietor?:No
Enumeration Date:2014-09-29
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1927133V00000X
OK21510373174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No174H00000XOther Service ProvidersHealth Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100732910-AOtherGROUP MEDICAID
OK200555940-AMedicaid
OK73-1042545OtherGROUP MEDICARE
OK73-1042545OtherGROUP BCBS
OK731042545001OtherGROUP TRICARE
OK100732910-GOtherGROUP MEDICAID
OK73-1042545OtherGROUP COMMUNITY CARE OF OKLAHOMA