Provider Demographics
NPI:1487625174
Name:SNOW-MCCAFFREY, KATHRYN A (APRN MSN GNP)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:A
Last Name:SNOW-MCCAFFREY
Suffix:
Gender:F
Credentials:APRN MSN GNP
Other - Prefix:MRS
Other - First Name:KATE
Other - Middle Name:A
Other - Last Name:MCCAFFREY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN MSN NP
Mailing Address - Street 1:7268 CAMPBELL TRL
Mailing Address - Street 2:
Mailing Address - City:INDIAN RIVER
Mailing Address - State:MI
Mailing Address - Zip Code:49749-9221
Mailing Address - Country:US
Mailing Address - Phone:231-420-3887
Mailing Address - Fax:231-526-2212
Practice Address - Street 1:7268 CAMPBELL TRL
Practice Address - Street 2:
Practice Address - City:INDIAN RIVER
Practice Address - State:MI
Practice Address - Zip Code:49749-9221
Practice Address - Country:US
Practice Address - Phone:231-420-3887
Practice Address - Fax:231-526-2212
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIKS097301363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5008769310OtherBCBS
MI1487625174Medicaid
MI104942358Medicaid
MIP00356871OtherRAILROAD MEDICARE