Healthcare Provider Details

I. General information

NPI: 1124451422
Provider Name (Legal Business Name): JESSICA ANN PALMA NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA ANN THOMPSON NP-C

II. Dates (important events)

Enumeration Date: 08/10/2013
Last Update Date: 11/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 S BERETANIA ST SUITE 750
HONOLULU HI
96814-1870
US

IV. Provider business mailing address

4002 MAKALIKE PL
HONOLULU HI
96816-4455
US

V. Phone/Fax

Practice location:
  • Phone: 808-356-5614
  • Fax: 808-538-3957
Mailing address:
  • Phone: 808-356-5614
  • Fax: 808-538-3957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1564
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number1564
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: