Provider Demographics
NPI:1275799967
Name:SNIPES, JUSTIN WAYNE (FNP)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:WAYNE
Last Name:SNIPES
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3086
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28680-3086
Mailing Address - Country:US
Mailing Address - Phone:828-438-8577
Mailing Address - Fax:828-438-8507
Practice Address - Street 1:219A AVERY AVE
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-3102
Practice Address - Country:US
Practice Address - Phone:828-438-8577
Practice Address - Fax:828-438-8507
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-01
Last Update Date:2016-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5004030207Q00000X, 363L00000X
NCF0608042363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7004840Medicaid
NC5004030OtherFNP LICENSE
NC5004030OtherFNP LICENSE