Provider Demographics
NPI:1659463529
Name:SNELL, KRISTINA MARIE (RMA)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:MARIE
Last Name:SNELL
Suffix:
Gender:F
Credentials:RMA
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:MARIE
Other - Last Name:BRICKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RMA
Mailing Address - Street 1:PO BOX 155
Mailing Address - Street 2:REA CLINIC
Mailing Address - City:CHRISTOPHER
Mailing Address - State:IL
Mailing Address - Zip Code:62822
Mailing Address - Country:US
Mailing Address - Phone:618-724-2401
Mailing Address - Fax:618-724-2436
Practice Address - Street 1:201 E N AVENUE
Practice Address - Street 2:CLAY MEDICAL CENTER
Practice Address - City:FLORA
Practice Address - State:IL
Practice Address - Zip Code:62839
Practice Address - Country:US
Practice Address - Phone:618-662-8386
Practice Address - Fax:618-662-4338
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical