Provider Demographics
NPI:1043275480
Name:SNYDER, KATHERIN KLOKKENGA (RD, LD/N, CDE)
Entity Type:Individual
Prefix:MRS
First Name:KATHERIN
Middle Name:KLOKKENGA
Last Name:SNYDER
Suffix:
Gender:F
Credentials:RD, LD/N, CDE
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:A
Other - Last Name:KLOKKENGA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1981 CAPITAL CIRCLE NE
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303
Mailing Address - Country:US
Mailing Address - Phone:850-431-4744
Mailing Address - Fax:850-431-6325
Practice Address - Street 1:1981 CAPITAL CIRCLE NE
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303
Practice Address - Country:US
Practice Address - Phone:850-431-4744
Practice Address - Fax:850-431-6325
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164-004222133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK13007Medicare ID - Type Unspecified