Provider Demographics
NPI:1437885571
Name:SNERLING, TKEYAH
Entity Type:Individual
Prefix:
First Name:TKEYAH
Middle Name:
Last Name:SNERLING
Suffix:
Gender:F
Credentials:
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 174
Mailing Address - Street 2:
Mailing Address - City:TUTWILER
Mailing Address - State:MS
Mailing Address - Zip Code:38963-0174
Mailing Address - Country:US
Mailing Address - Phone:662-313-0584
Mailing Address - Fax:
Practice Address - Street 1:1221 GOOSEPOND CIR
Practice Address - Street 2:
Practice Address - City:TUTWILER
Practice Address - State:MS
Practice Address - Zip Code:38963-5233
Practice Address - Country:US
Practice Address - Phone:662-313-0584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-30
Last Update Date:2022-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS801510643172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver