Individual provider Active NPI

Angela Snyder, RN/NP

  • Pediatric Nurse Practitioner
  • Memphis, TN
National Provider Identifier
1114904893
Registry record updated Dec 21, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
84345 Issued in TN
Practice address
332 N Lauderdale St
Ms 106
Memphis, TN 38105-2729
Phone
(901) 495-3006
Fax
(901) 495-3842
NPI assigned
Dec 23, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 84345 TN Primary

Addresses

Primary practice location

332 N Lauderdale St
Ms 106
Memphis, TN 38105-2729

Mailing address

332 N Lauderdale St
Ms 106
Memphis, TN 38105-2729
Phone (901) 495-3006

Other identifiers 1

IdentifierTypeStateIssuer
3496406MedicaidTN

Other names 1

  • Angela Toles Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220825000639 TN Practitioner - Nurse Practitioner 2860632502 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner, Registered Nurse

State licenses

LicenseStateTypeSpecialty
7502TNMDOrthodontics and Dentofacial Orthopedic Dentist
84345TNMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St Jude Children'S Research Hospital, Inc. Pediatrics CurrentSince Jul 13, 2022 Accepting new patients

Locations

262 Danny Thomas Pl
#106
Memphis, TN 38105
Phone (888) 419-5833

262 Danny Thomas Pl
Memphis, TN 38105
Phone (888) 226-4343

262 Danny Thomas Pl
#515
Memphis, TN 38105
Phone (901) 495-3006

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1135296000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1482278400000",
    "number": "1114904893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "332 N LAUDERDALE ST",
            "address_2": "MS 106",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381052729",
            "telephone_number": "901-495-3006",
            "fax_number": "901-495-3842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "332 N LAUDERDALE ST",
            "address_2": "MS 106",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381052729",
            "telephone_number": "901-495-3006",
            "fax_number": "901-495-3842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SNYDER",
        "first_name": "ANGELA",
        "credential": "RN/NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-23",
        "last_updated": "2016-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "TN",
            "license": "84345",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3496406",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANGELA",
            "last_name": "TOLES",
            "credential": "RN/NP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Memphis, TN

Sources for this page

Verify at the official NPI Registry.