Provider Demographics
NPI:1902080229
Name:SNOOK, BRANDY M (CRNA)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:M
Last Name:SNOOK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:838 MCKAY RD
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:GA
Mailing Address - Zip Code:31032-3818
Mailing Address - Country:US
Mailing Address - Phone:785-213-1207
Mailing Address - Fax:
Practice Address - Street 1:1770 WATSON BLVD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-3632
Practice Address - Country:US
Practice Address - Phone:478-333-6961
Practice Address - Fax:478-333-6964
Is Sole Proprietor?:No
Enumeration Date:2007-12-21
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-98084-101367500000X
GARN170157367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered