Provider Demographics
NPI:1902129794
Name:SNODDY, KEVIN LEE (PA-C)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:LEE
Last Name:SNODDY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7150 W SUNSET RD STE 200
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-1982
Mailing Address - Country:US
Mailing Address - Phone:702-385-4342
Mailing Address - Fax:702-385-4346
Practice Address - Street 1:2310 CORPORATE CIR STE 200
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7729
Practice Address - Country:US
Practice Address - Phone:702-735-8000
Practice Address - Fax:775-727-5696
Is Sole Proprietor?:No
Enumeration Date:2010-03-08
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1902129894Medicaid
NVDG359WMedicare PIN
NVDG359XMedicare PIN