Basic Information
| Provider Information | |||||||||
| NPI: | 1083268254 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SNOW | ||||||||
| FirstName: | TABETHA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 90 SOUTHSIDE AVE STE 350 | ||||||||
| Address2: | |||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288014184 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8283480760 | ||||||||
| FaxNumber: | 8282774847 | ||||||||
| Practice Location | |||||||||
| Address1: | 5533 BURLINGTON RD | ||||||||
| Address2: | |||||||||
| City: | MC LEANSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 273019622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366980045 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2019 | ||||||||
| LastUpdateDate: | 03/05/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 5012050 | NC | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LP2300X | 5012050 | NC | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care | 363L00000X | 5012050 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LF0000X | 5012050 | NC | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.