Provider Demographics
NPI:1225656689
Name:SNYDER, KIMBERLY (RD)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:
Last Name:SNYDER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16387 E 2050TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIDALGO
Mailing Address - State:IL
Mailing Address - Zip Code:62432-2118
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16387 E 2050TH AVE
Practice Address - Street 2:
Practice Address - City:HIDALGO
Practice Address - State:IL
Practice Address - Zip Code:62432-2118
Practice Address - Country:US
Practice Address - Phone:217-273-2266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered