Provider Demographics
NPI:1619543691
Name:SNYDER, MARY KINSLEY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KINSLEY
Last Name:SNYDER
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 1:300 20TH AVE N STE 403
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-5180
Mailing Address - Country:US
Mailing Address - Phone:611-539-6682
Mailing Address - Fax:
Practice Address - Street 1:1840 MEDICAL CENTER PKWY STE 405
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-3237
Practice Address - Country:US
Practice Address - Phone:615-396-6829
Practice Address - Fax:615-396-6840
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-01
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4695363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant