Healthcare Provider Details

I. General information

NPI: 1750196127
Provider Name (Legal Business Name): QUANESHA PALMER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2025
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 LIBERTY DR
DE WITT AR
72042-3430
US

IV. Provider business mailing address

PO BOX 127
BARTON AR
72312-0127
US

V. Phone/Fax

Practice location:
  • Phone: 870-946-3569
  • Fax:
Mailing address:
  • Phone: 870-714-9838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number232042
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: