Provider Demographics
NPI:1427227883
Name:SNIDER, JILL B (FNP)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:B
Last Name:SNIDER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:JILL
Other - Last Name:BLEVINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1785 W LEE HWY
Mailing Address - Street 2:
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382-1437
Mailing Address - Country:US
Mailing Address - Phone:276-228-6499
Mailing Address - Fax:276-228-6165
Practice Address - Street 1:1785 W LEE HWY
Practice Address - Street 2:
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-1437
Practice Address - Country:US
Practice Address - Phone:276-228-6499
Practice Address - Fax:276-228-6665
Is Sole Proprietor?:No
Enumeration Date:2008-02-29
Last Update Date:2017-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024167068363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007696167Medicaid