Provider Demographics
NPI:1972875847
Name:SNOOK, KORTNI R (NP)
Entity Type:Individual
Prefix:
First Name:KORTNI
Middle Name:R
Last Name:SNOOK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2511
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803-2511
Mailing Address - Country:US
Mailing Address - Phone:417-781-0250
Mailing Address - Fax:417-781-2581
Practice Address - Street 1:1002 MCINTOSH CIR
Practice Address - Street 2:SUITE 6
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3642
Practice Address - Country:US
Practice Address - Phone:417-781-0250
Practice Address - Fax:417-781-2581
Is Sole Proprietor?:No
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012002552363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily