Healthcare Provider Details

I. General information

NPI: 1497691505
Provider Name (Legal Business Name): BLUE PALM MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18666 W MCNEIL ST
GOODYEAR AZ
85338-4910
US

IV. Provider business mailing address

18666 W MCNEIL ST
GOODYEAR AZ
85338-4910
US

V. Phone/Fax

Practice location:
  • Phone: 678-340-1015
  • Fax:
Mailing address:
  • Phone: 678-340-1015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JANA HOLLYANN WHITE
Title or Position: OWNER
Credential: NURSE PRACTITIONER
Phone: 678-340-1015