Provider Demographics
NPI:1497152458
Name:SNOW, DONNA DEMETRAL (CNP)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:DEMETRAL
Last Name:SNOW
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3972 BETHAL ROBERTS RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MS
Mailing Address - Zip Code:39345-3109
Mailing Address - Country:US
Mailing Address - Phone:601-683-3969
Mailing Address - Fax:601-683-4303
Practice Address - Street 1:701 NORTHSIDE DR
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MS
Practice Address - Zip Code:39345-2361
Practice Address - Country:US
Practice Address - Phone:601-683-4300
Practice Address - Fax:601-683-4303
Is Sole Proprietor?:No
Enumeration Date:2014-11-19
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR863971363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health