Healthcare Provider Details

I. General information

NPI: 1518130707
Provider Name (Legal Business Name): ROBERTA CHERYL PRITCHARD-PALMER APRN,BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2008
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7210 W MAIN ST
BELLEVILLE IL
62223-3038
US

IV. Provider business mailing address

7210 W MAIN ST
BELLEVILLE IL
62223-3038
US

V. Phone/Fax

Practice location:
  • Phone: 618-398-9850
  • Fax: 618-398-9849
Mailing address:
  • Phone: 618-398-9850
  • Fax: 618-398-9849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209004511
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code364SP0810X
TaxonomyChild & Family Psychiatric/Mental Health Clinical Nurse Specialist
License Number209007072
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: