Healthcare Provider Details

I. General information

NPI: 1629098900
Provider Name (Legal Business Name): BETH MICHELLE PALMER NP, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 01/13/2026
Certification Date: 01/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3111 CAMINO DEL RIO N STE 400
SAN DIEGO CA
92108-5724
US

IV. Provider business mailing address

6180 COLT PL UNIT 106
CARLSBAD CA
92009-1817
US

V. Phone/Fax

Practice location:
  • Phone: 619-906-8156
  • Fax:
Mailing address:
  • Phone: 858-204-2171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number295062
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number295062
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number295062
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number295062
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: