Provider Demographics
NPI:1659754026
Name:SNYDER, BAMBI RACQUEL (APRN)
Entity Type:Individual
Prefix:
First Name:BAMBI
Middle Name:RACQUEL
Last Name:SNYDER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 WALLACE AVE
Mailing Address - Street 2:
Mailing Address - City:LEITCHFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42754-1479
Mailing Address - Country:US
Mailing Address - Phone:270-230-0182
Mailing Address - Fax:270-230-0104
Practice Address - Street 1:1895 ELIZABETHTOWN RD
Practice Address - Street 2:
Practice Address - City:LEITCHFIELD
Practice Address - State:KY
Practice Address - Zip Code:42754-9138
Practice Address - Country:US
Practice Address - Phone:270-230-0182
Practice Address - Fax:270-230-0104
Is Sole Proprietor?:No
Enumeration Date:2015-07-03
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3009451363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100367730Medicaid
KYK153140Medicare PIN