Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 6419P | KY |
NPI | 1992023816 |
---|---|
Provider Name | Andrea Palmer |
First Address | Elizabethtown, KY 42702-2119 |
Second Address | Bardstown, KY 40004-3214 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2010 |
Last Update Date | 17/05/2010 |