Provider Demographics
NPI:1992352454
Name:SNOW, KIRSTEN JANEL (PA-C)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:JANEL
Last Name:SNOW
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PCS BOX 20129
Mailing Address - Street 2:
Mailing Address - City:CAMP LEJEUNE
Mailing Address - State:NC
Mailing Address - Zip Code:28542-0129
Mailing Address - Country:US
Mailing Address - Phone:910-451-5125
Mailing Address - Fax:
Practice Address - Street 1:HM SMITH BOULEVARD
Practice Address - Street 2:BLDG FC-308
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28542
Practice Address - Country:US
Practice Address - Phone:910-451-5125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-20
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1148866OtherNCCPA