Individual
MS. TINA L SNODGRASS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN, FNP-C
Contact information
Practice address
1219 N MAIN ST STE 2, BEAVER DAM, KY 42320-8955
(270) 926-0707
Mailing address
1219 N MAIN ST STE 2, BEAVER DAM, KY 42320-8955
(270) 926-0707
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
3002620
KY
363LF0000X
Family Nurse Practitioner
3002620
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
K030132
MEDICARE PTAN
KY
01
—
K080520
MEDICARE GROUP PTAN
KY
Enumeration date
10/04/2006
Last updated
04/17/2023
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