Healthcare Provider Details

I. General information

NPI: 1114453743
Provider Name (Legal Business Name): PALMER AUDIOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2017
Last Update Date: 05/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N QUANAH AVE
RUSSELLVILLE AR
72801-2762
US

IV. Provider business mailing address

200 N QUANAH AVE
RUSSELLVILLE AR
72801-2762
US

V. Phone/Fax

Practice location:
  • Phone: 479-968-7250
  • Fax: 479-890-6345
Mailing address:
  • Phone: 479-968-7250
  • Fax: 479-890-6345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License NumberA151
License Number StateAR

VIII. Authorized Official

Name: DR. CHARLES T PALMER
Title or Position: AUDIOLOGIST
Credential: AU.D.
Phone: 479-968-7250