MEDICARE: KATHERINE SMITH PALMGREN PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	5014369	NC

General Provider Information

NPI Number	:	1114504016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE SMITH PALMGREN PMHNP-BC

Provider Business Mailing Address
First Line	:	7400 CARMEL EXECUTIVE PARK DR STE 155
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-8242
Country	:	US
Telephone Number	:	828-350-1177
Fax Number	:	828-350-1188

Provider Business Practice Location Address
First Line	:	7400 CARMEL EXECUTIVE PARK DR STE 155
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-8242
Country	:	US
Telephone Number	:	828-350-1177
Fax Number	:	828-350-1188

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2021
Last Update Date	:	08/19/2022

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