Tina Snodgrass Derm, PLLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

3002620 Issued in KY

Legal business name

TINA SNODGRASS DERM, PLLC

Practice address

1219 N Main St Ste 2
Beaver Dam, KY 42320-8955

Phone

(270) 926-0707

NPI assigned

Mar 19, 2013

Last updated

Dec 5, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Tina Snodgrass, APRNNPI 1962598557

Title

President

Phone

(270) 929-5578

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in KY

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Tina L Snodgrass, APRN, FNP-C

  • Dermatology Physician
  • Beaver Dam, KY
  • NPI 1962598557

  Family

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1363651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733356800000",
    "number": "1619219581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1219 N MAIN ST STE 2",
            "city": "BEAVER DAM",
            "state": "KY",
            "postal_code": "423208955",
            "telephone_number": "270-926-0707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1219 N MAIN ST STE 2",
            "city": "BEAVER DAM",
            "state": "KY",
            "postal_code": "423208955",
            "telephone_number": "270-926-0707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TINA SNODGRASS DERM, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-19",
        "last_updated": "2024-12-05",
        "certification_date": "2024-12-05",
        "status": "A",
        "authorized_official_last_name": "SNODGRASS",
        "authorized_official_first_name": "TINA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "270-929-5578",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": "3002620",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Nurse Practitioner in Beaver Dam, KY
• Providers in Beaver Dam, KY by specialty
• Family Nurse Practitioner in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.