Healthcare Provider Details

I. General information

NPI: 1386668440
Provider Name (Legal Business Name): DEANNA CAROL PALMER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 05/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1306 VERSAILLES ROAD STE 120
LEXINGTON KENTUCKY
40504
UM

IV. Provider business mailing address

548 BROOKWATER LN
LEXINGTON KY
40515-6036
US

V. Phone/Fax

Practice location:
  • Phone: 859-259-0717
  • Fax: 859-254-7874
Mailing address:
  • Phone: 859-271-4579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3003262
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: