Provider Demographics
NPI:1437622776
Name:SNOW, JYNNAH LEIGH (FNP)
Entity Type:Individual
Prefix:
First Name:JYNNAH
Middle Name:LEIGH
Last Name:SNOW
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 11TH AVE S STE 200
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-5074
Mailing Address - Country:US
Mailing Address - Phone:208-639-1514
Mailing Address - Fax:208-639-2301
Practice Address - Street 1:320 11TH AVE S STE 200
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-5074
Practice Address - Country:US
Practice Address - Phone:208-639-1514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-09
Last Update Date:2023-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID60441207Q00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine