Provider Demographics
NPI:1629807797
Name:SNIDER, KIMBERLEE JO (RN)
Entity type:Individual
Prefix:
First Name:KIMBERLEE
Middle Name:JO
Last Name:SNIDER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KIMBERLEE
Other - Middle Name:JO
Other - Last Name:MARS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:42870 S COUNTY ROAD 214
Mailing Address - Street 2:
Mailing Address - City:MOORELAND
Mailing Address - State:OK
Mailing Address - Zip Code:73852-9038
Mailing Address - Country:US
Mailing Address - Phone:580-574-4927
Mailing Address - Fax:
Practice Address - Street 1:900 17TH ST
Practice Address - Street 2:
Practice Address - City:WOODWARD
Practice Address - State:OK
Practice Address - Zip Code:73801-2448
Practice Address - Country:US
Practice Address - Phone:580-254-5511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0105078163WE0003X
OKF0741269363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency