Provider Demographics
NPI:1912550617
Name:SNIPES, CARMEN JANAY (LVN)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:JANAY
Last Name:SNIPES
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 SHILOH RD APT 238
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-2448
Mailing Address - Country:US
Mailing Address - Phone:903-714-0395
Mailing Address - Fax:
Practice Address - Street 1:1717 SHILOH RD APT 238
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-2448
Practice Address - Country:US
Practice Address - Phone:903-714-0395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX200522164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse